Author Names

Duzgun I, Turgut E, Eraslan L, Elbasan B, Oskay D, Atay OA

Reviewer Name

Megan Hayden, SPT

Reviewer Affiliation(s)

Duke University Doctor of Physical Therapy

 

Paper Abstract

Objectives: This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements.  Methods: This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization.  Results: Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05).  Conclusions: Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.  Keywords: Frozen Shoulder, Manual Therapy, Rehabilitation, Scapula, Posterior Capsule Go to:

 

NIH Risk of Bias Tool

Quality Assessment of Controlled Intervention Studies

  1. Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
  • Yes
  1. Was the method of randomization adequate (i.e., use of randomly generated assignment)?
  • Yes
  1. Was the treatment allocation concealed (so that assignments could not be predicted)?
  • Yes
  1. Were study participants and providers blinded to treatment group assignment?
  • Yes
  1. Were the people assessing the outcomes blinded to the participants’ group assignments?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
  • Yes
  1. Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
  • Yes
  1. Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
  • Yes
  1. Was there high adherence to the intervention protocols for each treatment group?
  • Yes
  1. Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
  • Yes
  1. Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
  • Yes
  1. Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
  • Yes
  1. Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
  • Cannot Determine, Not Reported, or Not Applicable
  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
  • Yes

 

Key Finding #1

There was no statistical difference between manual posterior capsule stretching, scapular mobilization, or both; however, all groups displayed improvements in ROM.

Key Finding #2

The study did not compare the effects of manual therapy to traditional exercise programs so more research needs to be conducted to examine any potential differences in treatment plans.

Key Finding #3

Only acute effects were measured; the impact of long-term effects was not examined in this study.

 

Please provide your summary of the paper

This was a RCT used to compare 2 manual therapy treatments on both shoulder ROM and pain levels for those with a level 3 frozen shoulder. Both decreased motion of the scapula and posterior shoulder capsule have been linked to limited improvements seen in those with frozen shoulder. Changes in pain were recorded using the VAS, and goniometry was used for pre and post-test measurements of shoulder flexion, abduction, and internal and external rotation. Overall, all 3 intervention groups showed statistically significant improvements in acute ROM and pain from pre and post-intervention. However, there was no difference between intervention groups.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

More research must be done to examine more long-term effects of these manual therapy treatments, and there was no examination that compared these treatments to traditional exercise therapy alone. However, all treatment groups displayed positive, acute changes. Physical therapists can use this information to guide their plan of care and having more options allows a PT to create unique plans of care based on what they are comfortable with and what the patient is comfortable with.