Efficacy of Scapular Stabilization Techniques in Improving Range of Motion and Functional Ability in Patients with Phase II Adhesive Capsulitis of the Shoulder Joint.

Research Article Critique

Jill Garcia, SPTA

Article Overview

Authors of research:

• Mithen, lecturer in physiotherapy and

• Nizar, head of department of physiotherapy- both from Kerala state, India

Date published:

• 2012 Indian Journal of Physiotherapy & Occupational Therapy

Sources: 6 used ranging from 1975-2000

Adhesive Capsulitis

Painful

Common cause of shoulder

pain

Gradual onset

Restricting

Definition:

“A condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder.”

-American Shoulder and Elbow Surgeons

Effects of Adhesive Capsulitis

Leads to tight pectoralis major, lattisimus dorci, teres major

Stretched & weakened middle/lower traps and rhomboids

Leading to early scapulothoracic motion…

Which decreases shoulder flexion

So…Purpose of the research:

“To find out the effect of scapular stabilization techniques along with conventional physiotherapy, in improving range of motion and functional ability in patients with phase 2 adhesive capsulitis.”

Sample: Research Design:

• Non-probability sampling method.

• randomly split into a control group and experimental group

• 6 days a week over a 2 week period.

• measurements were taken before and after.

• 30 participants

• Unilateral Phase II capsulitis (4-12 months)

• 55-65 years old

• Residing in Kerala state, India

• All male

Treatments

Control group

“Conventional physiotherapy”

1. short wave diathermy

2. passive stretching

3. mobilization

4. ROM exercise and teaching HEP’s

Experimental group

“Conventional physiotherapy” along with

scapular strengthening

Scapular Strengthening Exercises

Scapular Clock exercise

Towel Slide

Lawnmower

Ball Stabilization

Serratus Anterior Punch

Results (refer to table 3-5)

*SPADI- experimental group improved by 54% and control group by 43%

*ABD ROM- experimental group increased 35 degrees and control 21 degrees

*ER ROM- experimental group increased 21 degrees and control 10 degrees

CONTROL EXPERIMENTALSPADI ↑ 43% ↑ 54%ER ROM ↑ 10⁰ ↑ 21⁰ABD ROM ↑ 21⁰ ↑ 35⁰

The research found:

• a correlation between a stable scapula and improved ROM exists

• that by strengthening the muscles around the scapula, this can lead to significantly better outcomes when treating patients with adhesive capsulitis

Article Critique

Strengths

• Recently performed (2 years)

• Credible authors

• Good explanation of rationale for research

• Both inclusion and exclusion criteria were listed in the article

• Valid and reliable measurement tools

Weaknesses

• Small sample

• All male (selection error)

• Sources date back to 1975

• Doesn’t include explanation for why each scapular exercise was chosen

Questions to Consider

• What ROM/stretching exercises were included in the Home Exercise Programs? (it would be nice to know what the patients were doing at home

• Who performed the measurements? And were they done accurately?

• Who was supervising the exercises to make sure they were done accurately?

• Did the before and after measurements happen by the same person? Was there good inter-rater reliability?

• Were the chosen scapular exercises appropriate?

• Is 2 weeks long enough?

How can we implement this article into our clinic?

• External stabilization technique when stretching glenohumeral (pt supine)

• Don’t forget the scapula

• Incorporate scapular strengthening exercises

• Any other exercises to consider?

• Integrate the entire kinetic chain

Questions?

Comments?