Huang YH, Kuo YC, Hsieh LF, et al. Efficacy of Combination Therapy (Hydrodilatation and Subdeltoid Bursa Injection With Corticosteroid, Mobilization, and Physical Therapy) vs Physical Therapy Alone for Treating Frozen Shoulder: A Randomized Single-Blind Controlled Trial, Phase I. Arch Phys Med Rehabil. 2023 Dec 11:S0003-9993(23)00696-2. doi: 10.1016/j.apmr.2023.11.014. (Original study)

OBJECTIVE: To compare the efficacy of combination therapy (hydrodilatation and subdeltoid bursa injection with corticosteroid, mobilization, and physical therapy [PT]) with that of PT alone for treating frozen shoulder.

DESIGN: A prospective, 2-arm parallel, single-blinded, randomized controlled trial.

SETTING: Rehabilitation clinic of a private academic hospital.

PARTICIPANTS: Patients (n=70) with frozen shoulder (freezing stage).

INTERVENTIONS: Participants (n=35) in the combination group underwent hydrodilatation and subdeltoid bursa injection with corticosteroid twice, mobilization, and usual-care PT for 8 weeks; participants (n=35) in the PT group received only the usual-care PT for 8 weeks.

MAIN OUTCOME MEASURES: The Shoulder Pain and Disability Index (SPADI) was the primary outcome measure. The secondary outcome measures were pain scores on a visual analog scale, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), quality of life (evaluated using the 36-item Short-Form Health Survey [SF-36]), and self-assessment of the treatment effect.

RESULTS: Compared with the PT group, the combination group had significantly better pain (during activity), SPADI, SDQ, active and passive ROM, and self-assessment scores (all P<.001) as well as scores on some parts of the SF-36 (physical function and bodily pain, P<.05). Between-group differences were significant at the 1-, 2-, 4-, and 6-month follow-ups.

CONCLUSIONS: A combination of hydrodilatation (with corticosteroid), bursal corticosteroid injection, and joint mobilization with PT was superior to PT alone for treating frozen shoulder, and the effects persisted for at least 6 months.

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

Physician rater

This would need to be tempered with side effects such as septic joint.

Rehab Clinician (OT/PT) rater

"Patients (n=70) with frozen shoulder (freezing stage)." The absence of intervention blinding seems a concern. The homogeneity of the control and intervention group appears ill defined. The 'control' (usual PT treatment) and no control for CSI/water distension intervention fails to control for CSI/water distension and no Tx and/or no PTx. A potentially more effective intervention may be addressing the condition during the shorter window afforded by the "hot" stage of the condition (acute capsulitis) with CSI, heat and mobilisation. Education directed toward patient and practitioner groups to identify early stage adhesive capsulitis would be arguably and potentially of greatest cost/benefit.

Rehab Clinician (OT/PT) rater

The finding is deviated from the previous meta analysis and systematic review. It is worthy to explore this study in depth.
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