How long will this take ?

Please take a few minutes to read this article to better understand your diagnosis and prognosis.

There is no method to identifying an exact length of time it will take to recover from an injury. In medicine we use something called “best practice” to establish the plan of care (POC) for a patient. Using the plan of care we measure a patient’s progress with outcomes measures. The outcome measures we use must be tested using research to determine the validity and reliability of the test. Once a patient has a starting or baseline score, the outcome measure can be used periodically to establish his or her progress. Rather than using arbitrary numbers to determine progress, a mathematical formula is used to calculate the minimal detectable changes (MDC) and minimal clinical improvement to statistically track a patients progress.

The MDC is the minimum amount of change in a patient’s score that ensures the change isn’t the result of measurement error, also referred to as standard error of measure (SEM). The MCID is a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring.

Frozen Shoulder

Background and Purpose: The purpose of this study was to determine whether physical therapy interventions predicted meaningful short-term improvement in 4 measures of physical health, pain, and function for patients diagnosed with adhesive capsulitis.

Participants: Data were examined from 2,370 patients (mean age=55.3 years, SD=12.4; 65% female, 35% male) classified into ICD-9 code 726.0 who had completed an episode of outpatient physical therapy.

Methods: Principal components factor analysis was used to define intervention categories from specific treatments applied during the episode of care. A nested logistic regression model was used to identify intervention categories that predicted a 50% or greater change in Physical Component Summary-12 (PCS-12), physical function (PF), bodily pain (BP), and hybrid function (HF) scores.

Results: None of the patients achieved a 50% or greater improvement in PCS-12 scores. Improvement in BP scores was more likely in patients who received joint mobility interventions (odds ratio=1.35, 95% confidence interval=1.10–1.65). Improvement in HF scores was more likely in patients who received exercise interventions (odds ratio=1.50, 95% confidence interval=1.03–2.17). Use of iontophoresis, phonophoresis, ultrasound, or massage reduced the likelihood of improvement in these 3 outcome measures by 19% to 32%.

Limitations: The authors relied on clinician-identified ICD-9 coding for the diagnosis. Impairment measures were not available to support the diagnosis, and some interventions were excluded because of infrequent use by participating therapists.

Discussion and Conclusions: These results are consistent with findings from randomized clinical trials that demonstrated the effectiveness of joint mobilization and exercise for patients with adhesive capsulitis. Ultrasound, massage, iontophoresis, and phonophoresis reduced the likelihood of a favorable outcome, which suggests that use of these modalities should be discouraged.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of adhesive capsulitis. The articles report recent research and give an overview of the standards of practice for treatment of Adhesive Capsulitis both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Rill BK, Fleckenstein CM, Levy MS, et al. Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis.Am J Sports Med. 2011;39:567–574. Article Summary on PubMed.

Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010;38:2346–2356. Article Summary on PubMed.

Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89:419-429. Free Article.

Kelley MJ, McClure PW, Leggin BG. Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Ortho Sports Phys Ther. 2009;39:135-148. Article Summary on PubMed.

Levine WN, Kashyap CP, Bak SF, et al. Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg. 2007;16:569–573. Article Summary on PubMed.

Sheridan MA, Hannafin JA. Upper extremity: emphasis on frozen shoulder. Orthop Clin North Am. 2006;37:531–539. Article Summary on PubMed.

Diercks RL, Stevens M. Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg. 2004:13:499–502. Article Summary on PubMed.

1. Best practice
2. Plan of care
3. outcome measure-
4. validity-Correlation coefficient of 0.6 or above is excellant
5. Reliability – ICC above 0.75 is excellent
6. basline score
7. Minimal detectable change (MDC) (MDC = 1.96 x  SEM x square root of 2)
8. Minimal clinical improvement (MCID)
9. Standard error of measure (SEM) (SEM = Standard Deviation from the 1st test x (square root of (1-ICC))