Effectiveness of physical therapy in combination with NSAIDs and NSAIDs alone in patients with adhesive capsulitis

Abstract

This study was aimed to compare the effectiveness of the treatment regimen between combined technique of PT programme plus ibuprofen and ibuprofen alone for the treatment of adhesive capsulitis in terms of pain reduction and functional recovery measured by the change in The Shoulder Pain and Disability Index (the SPADI). The study design was randomised controlled trial. Ninety-six patients were diagnosed as adhesive capsulitis in outpatient clinic, Department of Rehabilitation Medicine and Department of Orthopaedic Surgery, Siriraj Hospital who met the eligibility criteria were randomly allocated to have a 3-week treatment protocol. The control group (n=48) had ibuprofen 400 mg three times daily. The study group (n=48) had ibuprofen 400 mg three times daily plus PT programme. PT programme was carried out 3 times a week. Each session comprised of short wave diathermy (20 minutes), mobilisation and passive glenohumeral joint stretching exercises to patients' tolerance. (On the day the patients did not receive hospital-based PT programme, they were encouraged to perform self-exercise.) All of the subjects were asked to receive no other adjuvant therapy during the study except oral acetaminophen. They were asked to stop acetaminophen 48 hours before next follow-up. At the end of the third week, The outcomes of each group were compared by in intention to treat analysis. The number of subjects included to the analysis was 45 from the control group and 47 from the study group. It was found that means (SD) of the improvement in the SPADI score of the study group and the control group were 19.4 (15.8) and 10.4 (13.6) respectively. The study group had mean improvement in the SPADI score 9 points more than control (95% CI: 2.9-15.1 points, p = 0.004). The differences in improvement of secondary outcome were in the same direction except the improvement in abduction and the amount of analgesic use, which the differences between the two groups were not significant different. The adverse reactions were generally mild and the compliance of treatment protocol was acceptable. There were few programme deviations. The results of this study gave us evidence to support the use of adjunctive physical therapy for patients with adhesive capsulitis.