Effect of Task-Specific Training in Frozen Shoulder

Background: Frozen shoulder, characterized by capsular thickening and capsular adhesions leads to pain, restricted ranges and disability. Task specific training focuses on use of functional activity along with repetitions which is based on concept of motor learning. This study has been done to evaluate the effect of task specific training in frozen shoulder. Methods: Ethical clearance was obtained from Institutional Ethical Committee, KIMSDU, Karad. 48 subjects were included in the study and were divided into two groups. Group A was treated with conventional physiotherapy treatment i.e. Hot Moist Pack, Ultrasound, Maitland mobilization and exercises and Group B was treated with conventional physiotherapy and task specific training. Results: In pre-intervention analysis no significant difference was seen with p values for Visual Analogue Scale (VAS) of 0.7236, for Range of Motion(ROM) for flexion of 0.4270 , extension of 0.6847, abduction of 0.9805, internal rotation of 0.9779, external rotation of 0.5946 and for Shoulder Pain and Disability Index (SPADI) pre-interventional p value was 0.3652. While post-interventional analysis showed extremely significant difference was seen in p value for VAS of 0.0027. While post-interventional analysis for ROM showed extremely significant difference for flexion with p<0.0001, very significant difference for extension with p=0.0065, extremely significant difference for abduction with p<0.0001, significant difference for internal rotation with p=0.0261, and very significant difference for external rotation with p=0.0097 and SPADI of p<0.0001. Conclusion: The study concludes that there is significant effect of task specific training in frozen shoulder. Key-words: task-specific training, frozen shoulder, range of motion, disability, pain, motor learning INTRODUCTION “Frozen shoulder or adhesive capsulitis is characterized by an insidious and progressive loss of active and passive mobility in the glenohumeral joint presumably due to capsular contracture. ” [1] Frozen shoulder affects 2-5 % of general population, with females being affected more than males. There is also evidence of non-dominant side being affected more than dominant side. [1,2] Frozen shoulder is categorized into three stages, stage 1 is freezing stage, stage 2 is frozen stage and stage 3 is thawing stage. In freezing stage the main symptom is pain with no marked limitation in range of motion, frozen stage shows gradual reduction in pain with marked reduction in range of motion, and thawing stage shows restoration of range of motion. [3] Task specific training, focuses on function that has evolved out of motor learning. The basis of task specific training, is goal directed functional activities instead of focusing on impairment reduction exercises, which leads to changes in the cortical representations. Only repetition and practice is not able to produce such changes, it must be accompanied along with some functional activity. Task oriented activity Amey Rajaram Sawant et.al. Effect of Task-Specific Training in Frozen Shoulder International Journal of Health Sciences & Research (www.ijhsr.org) 150 Vol.9; Issue: 6; June 2019 even if associated with less intensity is capable of cortical reorganization. [4] A complex interplay between internal structures as well as environment along with cognition and perception is required for performing functional tasks. [4,5] In frozen shoulder, for changes within capsule, higher amounts of forces must be applied; so it might be a possibility that the pain and stiffness are not present only due to capsular adhesions. Pain is a subjective phenomenon, and may be present even after healing of the capsule. Several studies have been done which study effect of therapeutic options on frozen shoulder, but there is paucity of rehabilitation protocol has been made to target central system along with shoulder joint in treatment of frozen shoulder. This study has been done to find out effect of task specific training in frozen shoulder. MATERIALS AND METHODS The study protocol was started after being approved by Institutional Ethical Clearance Committee of Krishna Institute of Medical Sciences „Deemed to Be‟ University, Karad for using human subjects in research. Informed consent was taken from all subjects before commencement of protocol. After protocol and ethical clearance, subjects who fulfilled the inclusion and exclusion criteria were selected and 48 subjects were recruited for the study. Subjects were divided into two groups using Consecutive Sampling with Random Allocation. Informed consent was taken from each of the subject prior to participation. Instructions were given to the subjects about techniques to be performed. Pre-Test VAS was used to assess the pain. Goniometer was used to assess the Range of motion. SPADI was used to assess the disability of patient.  Treatment protocol included hot moist pack (15 minutes), Ultrasound (7 minutes), Maitland mobilisation (10 glides in one set, 3 set in one session) and conventional exercises in Group A.  Treatment protocol included hot moist pack (15 minutes), Ultrasound (7 minutes), Maitland mobilisation (10 glides in one set, 3 set in one session) and task specific training in Group B.  Treatment was given for 4 weeks, 5 days/week for 45 minutes every day. TASK SPECIFIC TRAINING:  Exercises were taught according to the available range of the subjects.  The tasks which were allotted were simple and related to activities of daily living.  Three sets of ten repetition with 30 second hold were given.  Time and repetitions were noted, the subject was encouraged using verbal and visual cues while performing the tasks.  Participants were encouraged to complete the task in lesser time duration. The tasks were simplified or complicated by the therapist, according to the progression and in relation to