Effectiveness of electrophysical agents in subjects with frozen shoulder: a systematic review and meta-analysis

Abstract

Purpose

This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS).

Methods

A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results

The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low.

Conclusions

Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings.

IMPLICATION FOR REHABILITATION

• Although a clinical difference in pain and disability was observed, the certainty of the evidence was low.

• Ultrasound therapy is not recommended in patients with frozen shoulder.

• Electrophysical agents may not ensure adequate therapeutic efficacy.

Keywords:

• Electric stimulation therapy
• frozen shoulder
• laser therapy
• conservative treatment
• ultrasound
• extracorporeal shockwave therapy

Acknowledgements

The authors of this systematic review with meta-analysis really want to thank Professor Stergioulas for sharing the original data from his randomized controlled clinical trial. Moreover, the authors wish to express their profound gratitude to Dr Arianna Andriesse for accurately reviewing English language of the manuscript and to Dr Matteo Cioeta for the scientific advices.

Systematic Review Registration Number: CRD42022339120.

Level of Evidence: I, Meta-analysis.

Author contributions

Concept/idea: F. Brindisino and G. Girardi; research design: F. Brindisino, G. Girardi, M. Crestani, and A. Fiore; writing: F. Brindisino, M. Crestani, A. Fiore, and F. Struyf; data collection: F. Brindisino, G. Girardi, M. Crestani, G. Giovannico, and A. Fiore; data analysis: F. Brindisino, G. Girardi, M. Crestani, A. Fiore, D. Venturin, and F. Garzonio; project management: F. Brindisino, G. Girardi, M. Crestani, A. Fiore, and G. Giovannico; consultation (including review of manuscript before submitting): F. Brindisino, G. Girardi, M. Crestani, A. Fiore, D. Venturin, G. Giovannico, F. Garzonio, and F. Struyf; final approval of the manuscript: F. Brindisino, G. Girardi, M. Crestani, A. Fiore, D. Venturin, G. Giovannico, F. Garzonio, and F. Struyf.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.