The Effectiveness Of Muscle Energy Techniques For Treatment Of Patients With Early Adhesive Capsulitis: A Systematic Review.

Abstract

Abstract Title: The effectiveness of muscle energy techniques for treatment of patients with early adhesive capsulitis: A systematic review. Design of the study: Systematic review with narrative synthesis. Background and objectives: Adhesive capsulitis (AC), which is also known as frozen shoulder, is a common complaint and one of the most painful musculoskeletal conditions. The disease is characterised by the presence of thick fibrotic capsuloligamentous complex tissue around the shoulder. Patients in the early stages (acute and subacute) complain of severe pain and a significant level of shoulder disability. Muscle energy technique (MET) is a type of manual and soft tissue mobilisation treatment approach. Applying MET has been found to influence pain processes and produce hypoalgesia. Furthermore, MET has been found to increase the extensibility of the tissue, thereby minimising shoulder adhesion. More recently, MET has been used extensively to manage many musculoskeletal disorders and researchers have started to examine the effectiveness of MET for AC. However, despite the extensive literature about the therapeutic benefits of MET, there is no systematic review available; thus, the effectiveness of MET for AC remains a topic of debate. Therefore, the aim of this study is to address this knowledge gap by undertaking a systematic review of the published literature relating to the efficacy of MET for treatment patients with early AC. This work also considers whether MET is a beneficial for alleviating pain and reducing the level of disability in affected patients, as well as evaluating its effectiveness in comparison with traditional physiotherapy or other physiotherapy treatment approaches. Methods: A systematic review of randomised control trials (RCTs) was conducted. The search was conducted between 3rd and 14th October 2022 using the following databases: Web of Science, CINAHL, EMBASE, Medline, AMED, Scopus and PEDro. Grey literature databases were searched and manual searches of references and citations were conducted. Two reviewers independently evaluated the inclusion criteria and methodological quality of each RCT. After critical appraisal, data were extracted from the studies and synthesised. The authors of the studies were contacted to obtain missing data.

6

Results: Six RCTs with moderate quality, recruited a total of 415 participants. Five studies reported a statistically significant improvement in level of pain post intervention, while one study stated that pain increased post-MET intervention. Three of the studies claimed a statistically significant improvement in functional disability outcomes. While two studies found inconsistent and contradictory results regarding functional disability outcomes. Combining MET with conventional therapy could produce significant improvements in pain and shoulder disability scores relative to traditional physiotherapy interventions alone. However, comparing MET with manual/mobilisation interventions demonstrated that the other manual interventions were possibly more effective in terms of producing significantly better effects than MET. Conclusion: The evidence suggests that MET may be useful for treatment of early AC. However, the studies were not sufficiently robust to draw a firm conclusion. Several methodological errors and many introduced biases were reported. In addition to a significant gap in the evidence with generally a lack of technique descriptions.