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Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder Version 1.5, ‘Standard’ physiotherapy Endorsed by the Chartered Society of Physiotherapy Nigel Hanchard Lorna Goodchild Jackie Thompson Tracy O’Brien Dot Davison Christine Richardson Helen Watson Sibongile Mtopo Mary Wragg Martin Scott I
TABLE of CONTENTS Including main figures and tables Acknowledgements .................................................................................................................... IV Citation details ........................................................................................................................... IV Endorsement .............................................................................................................................. IV Minor revisions history .............................................................................................................. IV Due date for major update of the ‘standard physiotherapy’ module ....................................... IV Funding and competing interests ................................................................................................. IV Introduction ........................................................................................................................... 1 Please start here! ...................................................................................................................... 1 Preamble ................................................................................................................................... 1 Scope ........................................................................................................................................... 2 Exclusions ................................................................................................................................... 3 Aims and objectives .................................................................................................................... 3 Protocol ..................................................................................................................................... 4 Key research concepts and methods in brief ............................................................................. 4 Clinical trials ........................................................................................................................... 4 Systematic reviews and meta-analyses .................................................................................. 4 Cochrane Collaboration and Cochrane reviews ...................................................................... 5 Search for Cochrane reviews .................................................................................................. 5 Systematic review ................................................................................................................. 5 Questionnaire survey of CSP members .................................................................................. 5 GRADE system ......................................................................................................................... 6 Feedback from target audience ............................................................................................. 7 Future modules ...................................................................................................................... 7 Structure ..................................................................................................................................... 7 References to introduction ....................................................................................................... 8 Part 1: Background, diagnosis, assessment and overview of strategies for managing contracted (frozen) shoulder ........................................................................ 9 1.1. Anatomy of the shoulder .................................................................................................... 9 FIGURES 1.1a – h Movements at the shoulder ....................................................................... 10 1.2. From ‘50s shoulder’ to ‘contracted (frozen) shoulder’: a tour of terminology and pathology .................................................................................................................................................. 11 1.3. Diagnosing contracted (frozen) shoulder ........................................................................... 14 1.4. Reproducibility of physical tests for contracted (frozen) shoulder, and general guidance on applying the physical tests ................................................................................................... 16 FIGURE 1.2a A method for estimating passive external rotation ......................................... 18 FIGURE 1.2b Estimation of external rotation in 30° increments ......................................... 18 1.5. Other ‘tools’ for assessment ............................................................................................... 18 TABLE 1.1. Examples of combined pain‒function and pain outcome measures, with Minimum Clinically Important Differences ........................................................ 19 1.6. Summary of key points in diagnosis and assessment ............................................................. 19 1.7. An overview of treatment options ......................................................................................... 20 1.8. References to Part 1 ............................................................................................................... 26 II
Page 1: Eviidence-based clliiniicall guiide
Page 5 and 6: Acknowledgements The Guidelines Dev
Page 7 and 8: In the UK in particular, this leave
Page 9 and 10: Protocol As a measure against intro
Page 11 and 12: equired respondents to state whethe
Page 13 and 14: References to Introduction Buchbind
Page 15 and 16: Movements at the shoulder joint are
Page 17 and 18: descriptor, ‘long-life disease’
Page 19 and 20: then monarticular rheumatoid arthri
Page 21 and 22: Differential diagnosis between cont
Page 23 and 24: 1.2a), the tester can limit trunk r
Page 25 and 26: An overview of treatment options Th
Page 27 and 28: Manual mobilisations Background: Ma
Page 29 and 30: attributed to SWD and PSWD (see abo
Page 31 and 32: 1.8. References to Part 1 Buchbinde
Page 33 and 34: Kelley MJ, McClure PJ, Leggin BG (2
Page 35 and 36: 2. Systematic review and meta-analy
Page 37 and 38: 2.2. Methodological quality of tria
Page 39 and 40: Trial Eligibility criteria specifie
Page 41 and 42: 36 FIGURE 2.1 Functional outcome, m
Page 43 and 44: the 95% CI, a similarly directional
Page 45 and 46: study sample. This effect was not s
Page 47 and 48: Adjusted threshold for MCID (calcul
Page 49 and 50: Patient-completed section of ASES,
Page 51 and 52: Interpretation: There was no substa
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Adverse events, short term (5 weeks
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50 FIGURE 2.8 Functional outcome (S
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52 FIGURE 2.12 Passive external rot
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Interpretation: A clinically import
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physiotherapy in the pooled study s
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separately, whereas Ryans et al (20
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Adjusted threshold for MCID: MCID n
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Adjusted threshold for MCID (based
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Jüni P, Witschi A, Bloch R, Egger
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3. Recommendations for management o
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the population, muscle function ret
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3.1.6. In secondary care, should we
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outcomes, at this time point and lo
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physiotherapy with passive mobilisa
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Recommendation: Probably add outpat
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Physiotherapy versus other physioth
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Physiotherapy versus other treatmen
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Adding physiotherapy to other treat
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Facilitators Barriers CSP accredita
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4. Recommendations for research App
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Ginn KA, Cohen ML (2005). Exercise
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APPENDIX A: Methods i. Types of stu
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vi. Search methods for identificati
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We excluded those which: excluded
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ix. Grading the quality of evidence
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GRADE Working Group (2004) Grading
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Notes More patients in the placebo
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Accepted outcomes Period of data co
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showed any advantage which was clin
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Intervention/ Comparison(s) Accepte
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Notes Group averages (means?) were
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Accepted outcome(s) Period of data
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Intervention/ Comparison(s) Accepte
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APPENDIX C: Table of excluded studi
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1st Author Year Target condition In
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1st Author Year Target condition In
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Cleland J, Durall CJ (2002). Physic
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Thomas E, van der Windt DAWM, Hay E
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Improvement in pain score (follow-u
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Author(s): Ginn and Cohen (2005) (a
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Improvement in VAS for night pain (
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Author(s): Vermeulen et al (2006) (
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Author(s): Leung and Cheing (2008)
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Author(s): Leung and Cheing (2008)
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Improvement in VAS for night pain (
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Author(s): Ginn and Cohen (2005) Qu
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Author(s): Ginn and Cohen (2005) Qu
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iii. Physiotherapy versus combinati
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Improvement in passive external rot
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Improvement in pain (global) on 10-
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v. Adding physiotherapy elements to
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Passive external rotation (follow-u
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Improvement in pain (follow-up 6 we
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APPENDIX F: Delphi panellists Our i
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Comments/suggestion 23 The use of y
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APPENDIX I: Guidelines Development
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