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Physical therapy treatment for adhesive capsulitis: clinical evidence and clinical reasoning
  1. A Salam,
  2. S Hemmings,
  3. D Morrissey
  1. Centre for Sport & Exercise Medicine, Queen Mary, University of London, London, UK

Abstract

Background Many barriers exist impeding the translation of treatment evidence into practice for adhesive capsulitis (AC). The need for evidence-based practice is unquestionable, with reasoning skills needed to evaluate and apply the evidence. This study aims to combine published evidence and clinical reasoning to optimally guide clinical practice.

Objectives The first is to categorise and grade the evidence for each individual physical therapy treatment modality for AC, through a literature review. This informs the second; qualitative exploration of physiotherapists' perceptions of the evidence and its interaction with clinical reasoning.

Methods A systematic literature search was conducted for reviews and trials describing a physical therapy treatment for AC. Summaries of each individual modality were generated, and graded on the strength of supporting evidence. Semi-structured interviews were also conducted with experienced physiotherapists until data saturation.

Results The literature search yielded 26 studies, from which 19 physical therapy interventions were identified. Strong evidence exists to support the use of education, steroid injection, mobilisations, stretching, supervised exercise, home exercise, acupuncture, heat therapy, transcutaneous electrical nerve stimulation, non-steroidal anti-inflammatory drugs and interferential electrotherapy. Moderate evidence exists for six modalities, and limited evidence for two. Fourteen themes surrounding the assessment, treatment and evidence behind AC were identified from framework analysis of interview transcripts.

Conclusion There is relatively little high quality evidence in favour of one modality over another for AC. Until the quality and scope of evidence improves, clinicians will continue to rely heavily on their own expertise for treatment. These results are a meaningful guide to clinical practice, and reveal a number of research questions.

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