Effects of Activity Versus Structural Oriented Treatment Approach in Patients With Frozen Shoulder.

Study Overview
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Brief Summary
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The aim of this study is to compare the effects of activity versus structural oriented treatment approach on pain, range of motion, and function in diabetic patients with frozen shoulder.

Detailed Description
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Frozen shoulder, also known as adhesive capsulitis, is a condition of uncertain etiology, characterized by shoulder stiffness, severe pain, significant restriction of range of motions, and limitation in participation in socio-economical life. According to a concept, pain causes changes in the brain making it learn the non-use, and therefore, even after healing of peripheral structures has occurred, the brain may not be able to organize voluntary actions owing to the induced central changes. Physical therapy plays an important role to bring pain relief and return of functional motion in frozen shoulder and there are many approaches available that can be used but literature on treatments based on neuroplasticity is comparatively less. According to the research available, neuroplasticity has been effective in treating frozen shoulder. Similarly, PNF, home exercises, and joint mobilizations have also proven to be effective. The effects of the activity related and structural-oriented treatment on the frozen shoulder has not been addressed in diabetic patients yet. More RCTs are required to determine the best treatment for managing adhesive capsulitis in diabetics. Therefore, this research will be conducted which will compare the activity-based approach and the conventional approach to treating frozen shoulder in diabetics. The results may open new aspects of treating frozen shoulder in diabetics which can be cost-effective as well.

Official Title
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Effects of Activity Versus Structural Oriented Treatment Approach on Pain, Range of Motion, and Function in Patients With Frozen Shoulder.

Conditions
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Frozen Shoulder

Intervention / Treatment
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* Other: Activity oriented treatment
* Other: Structural oriented treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with frozen shoulder, limited ROM, and pain in the shoulder region Patients with diabetes from 10+ years Exclusion Criteria: History of headaches and dizziness Pain and limited ROM in the cervical spine Pain and limited ROM in temporomandibular joint

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Activity oriented<br>Activity-oriented therapy will be given to 15 patients which will train the structures around the shoulder in different activities of daily life. | Other: Activity oriented treatment<br>* 15 patients will be treated with activity oriented therapy. All subjects will receive 20 therapeutic sessions, 5 times a week over the time span of 4 weeks.<br>|
| Experimental: Structural oriented<br>Structural-oriented therapy will be given to 15 patients including a fixed sequence of physiotherapy techniques. | Other: Structural oriented treatment<br>* 15 patients will be treated with structural oriented therapy. All subjects will receive 20 therapeutic sessions, 5 times a week over the time span of 4 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NPRS for pain | The Numerical Pain Rating Scale (NPRS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain). | 4th week | 
| Goniometer for range of motion | It will be used to measure flexion, extension, abduction, adduction, and internal and external rotation of shoulder. | 4th week | 
| SPADI for pain and disability | Shoulder pain and disability index include thirteen questions measuring pain and disability on an eleven-point scale. O being no pain, difficulty and 10 being worst pain and difficulty. | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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frozen shoulder, manual therapy, proprioceptive neuromuscular facilitation, neuroplasticity, diabetes