A Randomised Clinical Trial Investigating The Most Appropriate Conservative Management Of A Frozen Shoulder

Abstract

‘Frozen Shoulder’ is a term which describes a combination of shoulder pain and stiffness that causes sleep disturbance and marked disability, and which runs a prolonged course (Hanchard et al 2011). Physiotherapy has been advocated; however there is no robust evidence on the superiority of any one treatment modality (Callinan et al 2003).

The aim of this study was to evaluate the effect of an exercise class compared to multimodal physiotherapy and a home exercise programme in patients with frozen shoulder. The objectives were to identify that clinical scores were effective at detecting change in the different treatment groups and to provide recommendations for the physiotherapeutic management of frozen shoulder. The study design was a randomised controlled trial with seventy five patients enrolled. The primary outcome measure was the Constant score, secondary outcome measures included the Oxford Shoulder Score (OSS), Hospital Anxiety and Depression Scale (HADS) and the short form 36 item health survey (SF-36). A repeated measures one- way analysis of variance on the outcome data was conducted.
Results from the Constant score and OSS indicate that at six weeks, six months and one year, an Exercise Class was more effective than Multimodal Physiotherapy or Home Exercises. The results from the HADS indicate that the Exercise Class was more effective than Multimodal Physiotherapy or Home Exercises at six weeks and six months. However, at one year Multimodal Physiotherapy was more effective than the Exercise Class and Home Exercises.
This study provides an original contribution to knowledge in frozen shoulder and has important implications for enhancing clinical practice. The findings suggest that a hospital based exercise class produced a rapid recovery with a minimum number of visits to the hospital. Physiotherapy could also be considered to optimise speed of recovery of frozen shoulder. The Constant score, OSS and HADS are recommended in the management of frozen shoulder. Finally, GPs and physiotherapists require training in the clinical diagnostic accuracy of frozen shoulder. The need for further research in this area is emphasized.