Exercise therapy is effective for improvement in range of motion, function and pain in patients with frozen shoulder: a systematic review and meta-analysis.

ABSTRACT Objective : To determine 1) the effect of exercise therapy alone or in combination with other interventions compared to solely exercises and programs with or without exercises? And 2) what kind of exercise therapy or combination with other interventions is most effective? Design : Systematic review and meta-analysis. Participants : Patients with frozen shoulder. Intervention : Exercise therapy as sole intervention or combined with other physical therapy interventions. Outcome measures : Range of motion (ROM), function, disability pain, muscle strength and patient satisfaction. Results : Thirty-three studies were included in the qualitative and 19 in the meta-analysis. Preliminary evidence was found for supervised exercises to be more beneficial than home exercises for ROM and function. Multimodal programs comprising exercises may result in little to no difference in ROM compared to solely exercises. Programs comprising muscle energy techniques show little to no difference in ROM when compared to programs with other exercises. Adding stretches to a multimodal program with exercises may increase ROM. There is uncertain evidence that there is a difference between those programs regarding function and pain. Preliminary evidence was found for several treatment programs including exercises to be beneficial for improvement in both passive and active ROM, function, pain, and muscle strength. No studies used patient satisfaction as an outcome measure. Conclusion : ROM, function and pain improve with both solely exercises and programs with exercises, but for ROM and pain there was little to no difference between programs and for function the evidence was uncertain. Adding exercises improve active ROM compared to a program without exercises, while adding physical modalities has no beneficial effect. Muscle energy techniques are a beneficial type of exercise therapy for improving function compared to other types of exercise. Unfortunately, no conclusion can be drawn about the results in the long-term and most effective dose of exercise therapy.