Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis

ABSTRACT

Background

Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions.

Objective

The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions.

Methods

Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form.

Results

Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low.

Conclusion

Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.

KEYWORDS:

• Adhesive capsulitis
• dosage
• exercise
• manual therapy

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplementary data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10669817.2023.2180702

Author contributions

KK and MM developed the concept idea, analyzed all data, and wrote the initial draft of the manuscript. MO, LB, and RTP conducted the literature search, collected data, and revised the manuscript. KK, MM, MO, and LB scored all included articles for their methodological quality. All authors approved the final version.

Additional information

Funding

The authors have no funding to disclose.

Notes on contributors

Kaitlin Kirker

Kaitlin Kirker is a physical therapist who holds a Doctorate of Physical Therapy (DPT), is board certified in orthopedics (OCS), and completed her fellowship training in orthopedic manual physical therapy at Bellin College. She is a staff physical therapist at Masefield and Cavallaro Physical Therapy in Brooklyn, NY, and is an Adjunct Assistant Professor in the DPT program at the Brooklyn Campus of Long Island University.

Melanie O’Connell

Melanie O’Connell is a physical therapist who holds a Doctor of Philosophy (PhD) and is board certified in pediatrics (PCS). She is an Assistant Professor and Director of Student Advisement and Engagement in the DPT program at the Brooklyn Campus of Long Island University and is a per diem physical therapist at the New Jersey Institute for Disabilities in the Early Intervention Program.

Lisa Bradley

Lisa Bradley is a physical therapist who holds a Doctorate of Physical Therapy (DPT) and a Masters in Social Work (MSW). She is an Associate Professor and the Director of Clinical Education in the DPT program at the Brooklyn Campus of Long Island University.

Rosa Elena Torres-Panchame

Rosa Elena Torres-Panchame is a physical therapist who holds a Doctorate of Physical Therapy (DPT), is board certified in orthopedics (OCS), and is a PhD candidate at Nova Southeastern University. She is the Assistant Program Director and Director of Clinical Education in the DPT program at St. John’s University, and a per diem physical therapist at Brooklyn Body Works Physical Therapy.

Michael Masaracchio

Michael Masaracchio is a physical therapist who holds a Doctorate of Physical Therapy (DPT) and Doctor of Philosophy (PhD).