de Sire A, Agostini F, Bernetti A, et al. Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews. J Pain Res. 2022 Aug 19;15:2449-2464. doi: 10.2147/JPR.S371513. eCollection 2022. (Systematic review)

Background: Frozen shoulder (FS) is a painful condition characterized by progressive loss of shoulder function with passive and active range of motion reduction. To date, there is still no consensus regarding its rehabilitative treatment for pain management.

Purpose: The aim of this umbrella review of systematic reviews was to analyze the literature, investigating the effects of non-surgical and rehabilitative interventions in patients suffering from FS.

Patients and Methods: A review of the scientific literature was carried out from 2010 until April 2020 using the following search databases: PubMed, Medline, PEDro, Scopus and Cochrane Library of Systematic Reviews. A combination of terms was used for the search: frozen shoulder OR adhesive capsulitis AND systematic review OR meta-analysis AND rehabilitation NOT surgery NOT surgical intervention. We included systematic reviews that specifically dealt with adults with FS, treated with non-surgical approaches. All the systematic reviews and meta-analyses included in the study that met the inclusion criteria were assessed using the Assessment of Multiple Systematic Reviews as a quality assessment tool.

Results: Out of 49 studies, only 14 systematic reviews respected the eligibility criteria and were included in this study. Their results showed an important heterogeneity of the studies and all of them agree on the lack of high-quality scientific work to prove unequivocally which rehabilitative treatment is better than the other. Due to this lack of gold standard criteria, there may be also a heterogeneity in the diagnosis of the reviews analyzed.

Conclusion: Non-surgical and rehabilitative interventions are undoubtedly effective in treating FS, but there is no evidence that one approach is more effective than the other regarding the methods reported. Future high-quality RCTs are needed to standardize the treatment modalities of each physiotherapy intervention to provide strong recommendations in favor.

Discipline Area Score
Physician 6 / 7
Nurse 5 / 7
Rehab Clinician (OT/PT) 5 / 7
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Comments from MORE raters

Nurse rater

I do love a good systematic review. The authors did a very good job of compiling and summarizing the study data in a very easy to read style. It was surprising to see that LLLT edged out most other treatments. This was definitely not something I knew before reading the article.

Physician rater

This review showed that non-surgical treatments are effective, but there is no clear answer about which type of non-surgical treatment is more effective.

Rehab Clinician (OT/PT) rater

The purpose of this umbrella review of systematic reviews is to synthesize the effect of the different rehabilitation interventions in the management of patients suffering from frozen shoulder. Meta-analyses, confidence interval and level of the evidence are not available in the paper. The paper adds to previous systematic reviews. Ultrasound and Low-Level Laser Therapy (LLLT) are recommended alternative interventions with positive outcomes. The conclusions are the same as of previous studies. There is a lack of evidence of high-quality studies analyzing the effects of rehabilitative approaches to the management for frozen shoulder.

Rehab Clinician (OT/PT) rater

As an Occupational therapist, I find these results surprising because there is no evidence that one approach is more effective than another regarding the treatment of Frozen Shoulder. Future high-quality studies are needed to standardize the treatment modalities within the rehabilitation.

Rehab Clinician (OT/PT) rater

This was a well-conducted and useful umbrella review. The results support the belief that physiotherapy, generally, can help impairments associated with adhesive capsulitis. The lack of elucidation of specific physiotherapeutic interventions most effective for this condition was not surprising, given the difficulty in determining the details of included systematic reviews, which themselves undoubtedly had the same problem with their included studies. Nonetheless, this study lends support to me as an orthopaedic and sports physiotherapist when educating clients and referral sources alike, on the effectiveness of physiotherapy in relieving impairments in clients with adhesive capsulitis.
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