School of Physical Therapy, Western University, London, Ontario, Canada.
School of Physical Therapy, Western University, London, Ontario, Canada.
Arch Phys Med Rehabil. 2019 Feb;100(2):350-365. doi: 10.1016/j.apmr.2018.08.181. Epub 2018 Sep 28.
This systematic review evaluated the effectiveness of nonsurgical interventions for managing adhesive capsulitis (AC) in patients with diabetes on pain, function, and range of motion.
MEDLINE and other databases were searched for studies published in the last 20 years.
Randomized controlled trials (RCTs) that assessed AC in people with diabetes and implemented 1 or a combination of physiotherapeutic interventions, corticosteroids, and manipulation under anesthesia (MUA) were eligible for inclusion.
The Cochrane Risk of Bias was used by 2 independent raters who met to achieve consensus. The quality of trials was assessed using Grading of Recommendations, Assessment, Development and Evaluations. Data extracted from the eligible studies included study design, participant characteristics and duration of symptoms, type of intervention, outcome measures, follow-up intervals, and research findings.
Because of the lack of similar interventions, a narrative synthesis was conducted, and meta-analyses were not performed. The effect sizes or between-group differences of the interventions were reported. A total of 8 RCTs met the inclusion criteria: 4 addressed physiotherapeutic interventions, 3 corticosteroid injections, and 1 MUA. The effect sizes for physiotherapeutic interventions were 0.8-2.0, 0.9-2.0, and 1.0 for ROM, function, and pain, respectively, with the largest effect size (2.0) being reported for joint mobilization plus exercises. The effect sizes for corticosteroids were 0.2-0.5 and 0.1 for ROM and pain. The between-group improvement for MUA was 5.6 points on Constant Shoulder Score.
Low-quality evidence suggests large effects of joint mobilization plus exercises on AC in people with diabetes, although confidence in this conclusion is limited due to the high risk of bias. Even weaker support was available for corticosteroid and MUA. Future high-quality RCTs are needed to determine the best intervention for managing AC in patients with diabetes.
本系统评价评估了非手术干预措施在糖尿病患者粘连性肩关节囊炎（AC）管理中的有效性，评估指标包括疼痛、功能和活动度。
检索了过去 20 年发表的 MEDLINE 和其他数据库中的研究。
纳入了评估糖尿病患者 AC 并实施了 1 种或多种物理治疗干预、皮质类固醇和麻醉下手法松解（MUA）的随机对照试验（RCT）。
由 2 名独立评估者使用 Cochrane 偏倚风险进行评估，评估者进行了面对面的讨论以达成共识。使用 Grading of Recommendations, Assessment, Development and Evaluations 对试验质量进行评估。从合格研究中提取的数据包括研究设计、参与者特征和症状持续时间、干预类型、结局测量、随访间隔和研究结果。
由于缺乏类似的干预措施，因此进行了叙述性综合，未进行荟萃分析。报告了干预措施的效应大小或组间差异。共有 8 项 RCT 符合纳入标准：4 项涉及物理治疗干预，3 项涉及皮质类固醇注射，1 项涉及 MUA。物理治疗干预的效应大小分别为 ROM、功能和疼痛的 0.8-2.0、0.9-2.0 和 1.0，其中关节松动术加运动的最大效应大小（2.0）。皮质类固醇的效应大小分别为 ROM 和疼痛的 0.2-0.5 和 0.1。MUA 的组间改善为 Constant 肩部评分的 5.6 分。
低质量证据表明关节松动术加运动对糖尿病患者 AC 有较大影响，但由于偏倚风险高，对这一结论的信心有限。皮质类固醇和 MUA 的支持更弱。需要未来进行高质量 RCT 来确定治疗糖尿病患者 AC 的最佳干预措施。
