At-Home Shoulder Exercises or Supervised Physical Therapy for Adhesive Capsulitis: A Retrospective Comparative Cohort...

The purpose of this study was to determine if the clinical outcomes of patients with adhesive capsulitis were influenced by the type of shoulder exercise regimen prescribed.

This was a retrospective, comparative cohort, therapeutic outcomes study of patients with primary or secondary systemic adhesive capsulitis who were initially treated with either a doctor-directed home-based exercise program (HEP) or the HEP supplemented with supervised physical therapy (SPT). Study participants were treated by one of two orthopaedists at a single institution between 2012 and 2022. Demographic and disease-specific data extracted from electronic medical records during the period of observation were compiled in an electronic database. Primary outcomes included shoulder range of motion (ROM) measures and treatment failures leading to operative intervention. Data were analyzed using the Friedman test and the Mann-Whitney U exact test.

There were 124 patients who met eligibility criteria, 81 in the HEP cohort and 43 in the SPT group. Intra-cohort comparisons showed significant increases in shoulder ROM in all planes between baseline and follow-up encounters (p<0.001), indicating clinical improvement with either shoulder rehabilitation method. However, inter-cohort comparisons demonstrated shoulder flexion and abduction were significantly greater in the HEP group than in the SPT group at both 8-week and final follow-up evaluations (p<0.001). While there were no treatment failures in the HEP cohort, 10 of 43 cases (23%) failed the SPT protocol, wherein an unconscious framing bias regarding treatment expectations and early operative intervention may have contributed to the high failure rate. Good clinical outcomes were obtained in all 10 cases with shoulder manipulation under anesthesia, arthroscopic global capsulotomy, and continued supervised physiotherapy.

Patients with adhesive capsulitis should be treated initially with at-home shoulder stretching exercises, reserving more costly supervised physical therapy or operative intervention for recalcitrant cases.

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