Rehabilitation of adhesive capsulitis of the shoulder: a new approach with telerehabilitation
Adhesive capsulitis of the shoulder, also known as frozen shoulder, is a condition characterized by progressive active and passive loss of range of motion of the shoulder joint resulting in stiffness and fixed continuous pain in the joint capsule.
Although reports of specific diagnoses in general populations are scarce, shoulder pain is common in the general population. Only from the primary care sector studies have found that decreased mobility occurs gradually, affecting up to 5% of the world’s population. Adhesive capsulitis of the shoulder is most common between the ages of 40 and 70 years and is more common in women and patients with thyroid disorders, diabetes, heart disease, or immune pathologies.
Causes and symptoms of adhesive capsulitis
The causes of shoulder stiffness can be many, and although the origin may often be unknown (about 50% of patients), we list some of them :
- Consequences of an inflammatory process
- A process inherent to the shoulder complex
- Systemic diseases
- Previous trauma
- Prolonged immobilization
- Previous shoulder surgery
The signs of adhesive capsulitis begin gradually and usually progress in three phases:
- Initial inflammatory phase: diffuse, severe pain
- Intermediate phase: stiffness, decreased joint range, and less pain
- Resolution phase: the progressive return of movement and resolution of pain
A physical examination will diagnose a limitation of joint movement, usually accompanied by pain, and will differentiate adhesive capsulitis from other conditions of the musculoskeletal system.
What is the treatment for frozen shoulder?
Treatment of stiff shoulder involves range-of-motion exercises, pain control measures with analgesics, anti-inflammatory drugs, or suprascapular nerve blocks to facilitate physiotherapy. A small percentage of patients require surgery to recover.
We focus on therapeutic exercise programs for the treatment of adhesive capsulitis. Joint mobilization techniques have beneficial effects, but in some cases, patients do not tolerate them due to pain. Obtaining superior clinical improvement depends on patient adherence to their therapeutic exercise program, which can be low in unsupervised home exercise programs. Empowering the patient motivates them to increase their participation in the whole therapeutic process to improve their health and quality of life. It is therefore important that the physiotherapist-patient relationship is fluid, as the rehabilitation of adhesive capsulitis often requires a high volume of individual rehabilitation sessions in the physiotherapist’s office. This is where telerehabilitation plays a crucial role, allowing the patient to complete the rehabilitation process remotely from anywhere and the physiotherapist to monitor the treatment accurately and remotely.
Telerehabilitation of adhesive capsulitis with the ReHub
At DyCare we set out to investigate the effectiveness of a new rehabilitation process for the treatment of adhesive capsulitis with the aim of reducing the traditional in-office treatment sessions and introducing additional exercise sessions performed at home autonomously by the patient with the ReHub telerehabilitation platform.
The study aimed to analyze the effect of self-directed home rehabilitation with ReHub for adhesive capsulitis of the shoulder over a 4-week period. The effect of traditional therapy, consisting of 3 sessions of in-office physiotherapy per week, was compared with a therapy consisting of 1 session per fortnight in office combined with 5 sessions of home-based self-exercise with ReHub per week.
The QuickDASH medical questionnaire is a tool to assess patients’ upper limb limitations through a series of questions. Despite starting from similar scores at the beginning of the study, patients on combination therapy improved by 67%, far ahead of the 23% improvement of patients on traditional therapy.
Patients who used ReHub at home achieved an average adherence of 74% to their exercise program. In addition, they rated their experience with ReHub with an average of 80/100 on the System Usability Scale questionnaire.
These are some of the conclusions of the study:
- The new treatment approach reduces the improvement time in the process of adhesive capsulitis and the stress of in-office sessions for both patients and practitioners
- The platform provides a good user experience for patients and motivates them to perform autonomous exercises at home
The results prove the fundamental role of a telerehabilitation platform such as ReHub where the patient becomes the protagonist of his rehabilitation process, empowering and motivating him to perform the therapy safely and accurately under the remote control of his physiotherapist.
Would you like to know all the details of our research? Download the study here.