Therapeutic Interventions for Managing Diabetic Shoulder
Abstract
Shoulder pain is a common complaint of diabetic patients that causes motion limitations and functional disability. Adhesive capsulitis (AC) is the most common disabling shoulder disorder. There is no optimal non-surgical treatment for managing AC in diabetic patients. Furthermore, the impact of diabetes on shoulder recovery and factors predicting shoulder function following shoulder arthroplasty is not well investigated.
Purpose and Methods
The main purpose of this thesis was to inform clinical practice about the best intervention for managing AC in diabetic patients, and to assess the impact of diabetes on functional outcomes after shoulder arthroplasty, with the following objectives: 1) To systematically review clinical research evaluating non-surgical interventions for managing AC in diabetic patients; 2) To pilot test study procedures and estimating the effects of incorporating a progressive walking program as an adjunct to a regular physiotherapy program for managing AC in diabetic patients; 3) To examine the effect of diabetes on shoulder function and physical health status, And 4) To determine factors that predict shoulder functional outcomes following shoulder arthroplasty.
Results
Eight randomized trials (RCTs) were evaluated in a systematic review. The largest effect size (2.0) was reported for joint mobilization plus exercises. The pilot RCT (n = 8) found that regular physiotherapy (PT) group and regular physiotherapy program plus progressive walking group (PT+) may improve functional performance and other outcomes, with a mean change of PT = 38±17, and PT+ = 6±33 seconds for Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) test from baseline to six weeks follow-up. A sample size of 89 participants per group is needed for future studies. Diabetic and non-diabetic patients showed significant improvements in function and physical health status following shoulder arthroplasty with no significant differences between groups. At one year after arthroplasty, residual pain significantly predicted poorer shoulder function.
Conclusions
We found that low-quality evidence suggested large effects of joint mobilization plus exercises on AC in people with diabetes. Conducting a large-scale study to assess the effect of incorporating a walking program for managing AC in patients with diabetes is feasible. Patients with and without diabetes may get equal surgical benefits, and residual pain may cause limitations in shoulder function one year after arthroplasty.