Corticosteroid plus exercise increases recovery in frozen shoulder patients: JAMA
UK: The early use of IA corticosteroid accompanied by a home exercise maximizes recovery chances in patients with frozen shoulder of less than 1-year duration, according to a recent meta-analysis in the journal JAMA Network Open.
Adhesive capsulitis (also known as frozen shoulder) is a common shoulder problem characterized by progressive loss of glenohumeral movements coupled with pain. Health care professional often face a difficulty in selecting appropriate treatment as there are myriad of available treatment options for patients with frozen shoulder. Dimitris Challoumas, University of Glasgow, Scotland, United Kingdom, and colleagues aimed to assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.
The researchers searched the online databases in February 2020. The systematic review and meta-analysis included studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment.
The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
The primary outcomes were pain and function and secondary outcome was external rotation range of movement (ER ROM). Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.
The systematic review included a total of 65 eligible studies with 4097 participants. 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses.
Key findings of the study include:
- Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, −1.0 visual analog scale [VAS] point; 95% CI, −1.5 to −0.5 VAS points; vs physiotherapy: MD, −1.1 VAS points, −1.7 to −0.5 VAS points) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7).
- Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, −1.4 VAS points; 95% CI, −1.8 to −1.1 VAS points).
"The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery," concluded the authors.
"Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis," is published in the journal JAMA Network Open.