Alsubheen SA, Nazari G, Bobos P, et al. Effectiveness of Nonsurgical Interventions for Managing Adhesive Capsulitis in Patients With Diabetes: A Systematic Review. Arch Phys Med Rehabil. 2019 Feb;100(2):350-365. doi: 10.1016/j.apmr.2018.08.181. Epub 2018 Sep 28. (Systematic review)

OBJECTIVE: This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion.

DATA SOURCES: MEDLINE and other databases were searched for studies published in the last 20 years.

STUDY SELECTION: Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion.

DATA EXTRACTION: The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings.

DATA SYNTHESIS: Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score.

CONCLUSION: Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.

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

Rehab Clinician (OT/PT) rater

This review provides the information on mobilization different from previous lines.

Rehab Clinician (OT/PT) rater

What makes this newsworthy is the findings of lack of uniform outcome measure to perform a meta-analysis for such a common problem. The methods used are also state-of-the-art for a systematic review.

Rehab Clinician (OT/PT) rater

This meta-analysis can only be used to draw weak conclusions as the number of studies included is not very large. It seems that there is only weak evidence to support the use of PT interventions, but the good thing is that it is better than the use of steroid or MUA approaches. More research is obviously necessary to make strong clinical recommendations for this condition.

Rehab Clinician (OT/PT) rater

This poor quality evidence doesn't really add anything to the discussion around management of adhesive capsulitis in the diabetic population.
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