The effects of end-range interventions in the management of primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis

Abstract

Purpose

To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC).

Methods

Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook.

Results

Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20–70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low.

Conclusions

Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC.

Implications for rehabilitation

• The Kaltenborn, Maitland, and Mulligan concepts are the most commonly used manual therapy approaches for adhesive capsulitis.

• The End-range mobilisation techniques seem to improve pain intensity, shoulder range of motion, and physical function at short- and medium-term of follow-up.

• The certainty of evidence was rated as very low for all the outcome measures.

• Despite the low certainty of evidence, it is recommended to continue using manual therapy for adhesive capsulitis due to the improvements demonstrated until further studies either confirm or refute its definitive efficacy.

Keywords:

• Shoulder
• adhesive capsulitis
• mobilisation
• range of motion
• systematic review
• meta-analysis

Disclosure statement

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

Additional information

Funding

This research received no external funding.