Non-surgical interventions for primary frozen shoulder: systematic review
Table II. Cont.
Domains
Effective blinding
Selective
a) participant
Intervention b) providers
c) objective outcomes
integrity Incomplete
outcome data Outcome country Sequence Allocation
generation concealment reporting Other sources Our evaluation
of bias
of risk of bias
Park et al. 2013 (78) Adequate Adequate Unclear Unclear GC, IFU,
Unclear Adequate IFU, USS, GC, High
Inadequate Adequate BLD, GC,
High
Unclear Unclear GC
Moderate
Unclear Adequate FSD, USS,
UIV, GC,
High
Inadequate Adequate GC, OMC, UIV, High
USS,
Unclear Unclear OMC, GC, IFU, High
UIV, USS,
Adequate Unclear GC, BLD,IFU
High
Unclear Adequate GC, IFU,
Low
Study, year publication,
Unclear
Korea
Park et al. 2014 (79)
Unclear
Unclear
Adequate
South Korea
Unclear
Shin et al. 2013 (81) Adequate
Unclear
Inadequate
c) Adequate
a) Not possible
c) Unclear
a) Not possible
b) Not possible
Adequate
Unclear
South Korea
c) Inadequate
a) Not possible
b) Not possible
Unclear
Unclear
Adequate
Japan
c) Adequate
a) Not possible
b) Not possible
Vahdatpour et al. 2014 (83) Unclear
Unclear
Adequate
Iran
c) Adequate
a) Adequate
b) Not possible
Taiwan c) Unclear
a) Mixed: not possible/
adequate
Yang et al. 2012 (85) c) Primary outcome:
adequate, Secondary:
unclear
a) Not possible
Wu et al. 2014 (84)
Inadequate Unclear
Inadequate
b) Not possible
Inadequate Inadequate
Adequate
b) Not possible
c) Adequate
a) Adequate
Yoon et al. 2013 (32)
one week, twice a day for 2–3 weeks, and three 30
min sessions per day in week 4. Follow-up assessment
occurred at 4, 12, 24 and 52 weeks and at all follow-
up time-points the findings favoured the progressive
static stretching and multi-modal group for the primary
outcome measures of interest. For the primary outcome
measures at 1 year there were significant improvements
in the progressive static stretching and multi-modal th-
erapy group, for passive external rotation (87° vs 39°),
for passive abduction (178° vs 133°), and for active
abduction (178° vs 84°). For the secondary outcome
measures, the results also favoured the progressive
static stretching group for DASH (at 12, 24 and 52
weeks) and for VAS (pain) at 24 and 52 weeks). At
52 weeks the DASH scores were 1.5 vs 55.3 and VAS
(pain) were 1.1 vs 3.1 (0 = no pain and 10 = worst
imaginable pain). The participants were taught how to
use the device by the principal investigator, a potential
source of bias, and data was collected at a single cen-
tre. Compliance data were collected, but not reported.
South Korea
High
b) Not possible
Schydlowsky et al. 2012
(80) Denmark
Tanaka et al. 2010 (82)
a) Not possible
b) Not possible
Taiwan
551
Adequate
Adequate
Adequate
b) Adequate
c) Adequate
Key: adequate, low risk of bias; inadequate, high risk of bias; unclear, potential risk of bias uncertain; partial, high/unclear risk to some procedures or outcomes.
BLD: concerns re: baseline differences (unclear/partial); COI: concerns re: conflict of interest (first author providing intervention/authors invented device); FSD:
diagnosis of frozen shoulder unclear or diagnosed by symptoms with no imaging; GC: generalizability concerns (e.g. single-site/treatment provider, choice of
inclusion/exclusion criteria); IFU: inadequate follow-up (pre-post-intervention or ≤12 weeks); USS: unjustified sample size (for example- not mentioned, no a
priori calculation, insufficient detail); OMC: outcome measure concerns (unclear measures/no functional outcome included); UIV: unclear intervention (e.g. lack
of detail/ varying durations/pre-trial treatment).
Comparison of different doses of intra-articular
corticosteroid injections
In a population (n = 53) of people in the initial pain
(freezing) stage of FS Yoon et al. (32) investigated
whether a single intra-articular injection of high-dose
(4 ml of 10 mg/ml triamcinolone acetonide and 1 ml of
1% lidocaine) (n = 20) improved pain and function in
patients with FS more than a low dose (2 ml of 10 mg/
ml triamcinolone acetonide and 3 ml of 1% lidocaine)
(n = 20) or a placebo (5 ml of 1% lidocaine) (n = 13).
Participants were described as having stage 2 of adhe-
sive capsulitis (freezing stage according to Hannafin &
Chiaia (16)) with at least one month of pain duration,
and mean pain intensity during a day defined as a score
of 3 points or more on a 10-cm visual analogue scale
rated from 0 (no pain) to 10 (worst imaginable pain).
The injections were performed in a hospital setting
and under ultrasound guidance. After the procedures
the participants were given a home programme that
involved stretching, Codman exercises, wall-climbing
J Rehabil Med 51, 2019