Physiotherapy treatment of the diabetic shoulder: health-related quality of life and measures of shoulder function regarding patients with type 1 diabetes

Abstract

Purpose: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period.

Method: A pre–post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced micro-circulation in the shoulder tissues, optimal shoulder co-ordination, and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale – Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment.

Results: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale – Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale – Swedish version. “Hand-raising” and “hand-behind-back” were significantly improved, and proved to be positively correlated with Shoulder Rating Scale – Swedish version.

Conclusions: The results of this study indicate that patients with type 1 diabetes and shoulder problems, treated with a specific physiotherapy programme, may improve with respect to physical aspects of health-related quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients.

Implications for Rehabilitation

• Diabetes is a significant risk factor in the development of shoulder pain and disability.

• Health-related quality of life (HRQoL) is affected in patients with diabetes and shoulder problems.

• A specific physiotherapy programme may improve physical aspects of HRQoL in patients with diabetes and shoulder problems.

• Specific physiotherapy intervention may also improve range of motion in the shoulder joint in patients with diabetes and shoulder problems.

Keywords:

• Physiotherapy
• health-related quality of life
• diabetes
• diabetic shoulder
• shoulder function

Acknowledgements

First, many thanks to the study group of patients. We would also like to thank Dr. Laura Laslett for so generously sharing her primary data. Thanks also to Helena Schröder Winter and Linda Andersson for their work with data collection.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by grants from Uppsala County Council [Grant-id 1080171].