Exploring The Efficacy of Self-Directed Active Exercise Program in Patients with Adhesive Capsulitis: A Systematic Scoping Review

Abstract

Introduction: Adhesive capsulitis (AC) is a common debilitating condition identified with painful reduction in range of motion of shoulder joint and functionality. Though its self-limiting nature, the recovery time is long and painful. This review has been aimed to throw light on efficacy of various active exercise programs used for management of AC.

Methodology: Articles were searched from Jan 2003 till Jan 2024 through electronic search engines such as PubMed, Google Scholar, PEDro, Scopus, and Science Direct using key words like Adhesive Capsulitis or frozen shoulder or stiff shoulder or painful shoulder or shoulder pain and active exercises or home exercise program or therapy or treatment. Randomized control trials (RCT) published in English language were included in the review. Studies were excluded if they had shoulder pain post mastectomy, rotator cuff disorders, forward head posture, post stroke, tendinopathy and if treatment was given digitally or AI assisted or pharmacologically. Quality of assessment of each study was done using Cochrane risk of bias tool 2 (RoB 2) for RCTs. Prisma Guidelines were followed to report the review.

Results: A total of 512 studies were identified out of which 10 RCTs were included for present review. 502 studies were excluded after duplicates and abstract/title screening. 634 participants with mean age 52.08 years (age range 22-90 years) were recruited in the studies reviewed. Low to moderate risk of bias was found for the studies evaluated in the present review. Home-based exercise alone as well as active self-managed exercise showed equal positive clinical improvement in reducing the pain intensity, increasing range of motion and functionality of the individuals.

Conclusion: Home-based or active exercises showed positive clinical improvements with no superior treatment. This highlights the substantial research gap in terms of high quality RCTs evaluating long term effects or follow ups of self-management exercise interventions in patients with adhesive capsulitis.