Efficacy of physiotherapy after hydrodilatation for the painful stiff shoulder: a randomised placebo-controlled trial

INTERVENTION: Participants were randomly assigned to a 6‐week physiotherapy or placebo treatment group, which commenced 3‐5 days after hydrodilatation. All hydrodilatations were performed according a standardized protocol. Depomedrol (40 mg, 1 ml) and normal saline were injected to a total volume of up to 90ml or until filling of the subscapular bursa, capsular rupture or participant requests termination of the procedure. Project physiotherapists were trained in the standardised protocol for both the physiotherapy and the placebo treatments. Both treatments were performed twice per week for the first two weeks and then once per week for the remaining four weeks (8 visits, 30 minutes each). The placebo treatment consisted of inoperable ultrasound and light application of an inert gel. The physiotherapy treatment was standardised and progressed according to specific criteria. Specific interventions included muscle stretching techniques both passive and self executed to stretch muscles passing over the glenohumeral joint, cervical and thoracic spine mobilisation, glenohumeral joint passive accessory glides, glenohumeral joint passive physiological mobilisation, strength and co‐ordination exercises for rotator cuff and scapular stabilisers, and proprioceptive challenge. CONDITION: Adhesive Capsulitis PRIMARY OUTCOME: The Shoulder Pain and Disability Index (SPADI) is a self‐administered shoulder‐specific disability index consisting of 13 items divided into pain and disability subscales. SECONDARY OUTCOME: 1. Participant's overall assessment of pain was measured with a 10‐cm Likert scale comprising a vertical line labeled "no pain" at the bottom (0) and "maximal imaginable pain" at the top. 2. Range of active shoulder movement was measured according to a standardised protocol. 3. The Assessment of Quality of Life (AQoL) instrument measures health‐related quality of life and can be converted into an utility index using utility weights derived from an Australian population sample. 4. Perceived recovery was measured on a 7‐point ordinal scale ranging from much worse to completely recovered to estimate the percentage of patients with a successful outcome, defined as much improved or completely recovered. 5. Adverse effects elicited by the use of open‐ended questions. 6. Costs including direct health care and non‐health care costs and indirect costs were elicited by self completed questionnaire/diary completed weekly for the entire 6‐month follow‐up period. INCLUSION CRITERIA: i) symptoms of pain and stiffness in predominantly one shoulder for > 3 months; ii) restriction of passive motion of greater than 30o in two or more planes of movement, measured to onset of pain with a gravity inclinometer; iii) adults.