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The efficacy of radial extracorporeal shockwave therapy in shoulder adhesive capsulitis: a prospective, randomised, double-blind, placebo-controlled, clinical study

PainSci » bibliography » Hussein et al 2016
Tags: treatment, devices

Two articles on PainSci cite Hussein 2016: 1. Does Ultrasound Therapy Work?2. Complete Guide to Frozen Shoulder

PainSci notes on Hussein 2016:

This test of shockwave therapy for frozen shoulder hits all the highlights of well-designed experiment. The researchers gave real shockwave therapy to one group of 52 patients weekly for a month, and sham shockwave therapy to the other group, and measured pain and function. The real shockwave group did “significantly” better, with the researchers notably claiming both statistical and clinical significance of the results … but not reporting the actual effect sizes in the abstract, which is always suspicious (if they are impressive, they get featured).

Despite the good design, a major concern here is that sham treatment. Shockwave therapy is high energy, and uncomfortable at best, painful at worst. In the sham group, the shockwaves were simply “blocked.” It seems like many or most patients would certainly know that they weren’t getting the real shockwave therapy … which would spoil the data for sure.

The results are very promising, but it’s a mystery why shockwave therapy would work, the effect they observed was probably not very large, and there’s probably one huge flaw that would be a deal-breaker.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Although shoulder adhesive capsulitis is a common condition, its treatment remains controversial. No previous radial extracorporeal shockwave therapy (rESWT) use has been reported for this condition. The objective of this study was to determine the effects of rESWT compared with placebo in patients with shoulder adhesive capsulitis. This prospective, randomised, double-blind, placebo-controlled, clinical trial took place in four physical therapy departments in New York. The study included 106 patients with primary shoulder adhesive capsulitis, who were randomly assigned to either the experimental (n = 53) or control group (n = 53). All patients received instructions in a home-based exercise program before their allocated intervention. Both groups received four applications of rESWT, 1 week apart; a clasp blocked transmission of the shockwave impulses in the control group. Function was measured by the Disabilities of the Arm, Shoulder and Hand questionnaire, pain by a visual analog scale, and shoulder active and passive abduction, and passive external rotation degrees by a goniometer, at baseline, and at 4 and 24 weeks from baseline. Compared to the control group, significant clinical and statistical (p < 0.001) improvements in all outcome measures were seen in the experimental group at the two follow-up intervals. In conclusion, the rESWT is a safe and effective treatment in shoulder adhesive capsulitis.

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