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Extracorporeal Shock Wave Therapy for Chronic Adhesive Capsulitis in Type 2 Diabetics: A Systematic Review with Meta-Analysis.

Crystal Reno,P. Swinton,Lyndsay Alexander

Published 2025 in Physical Therapy

ABSTRACT

OBJECTIVE The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy in the treatment of chronic adhesive capsulitis in the type 2 diabetes population. DESIGN This study is a systematic review with meta-analysis. The search was conducted in MEDLINE, EMBASE, CINAHL, PEDro, Cochrane Database of Systematic Reviews, UK Clinical Trial Gateway and grey literature from 2012 to 2023. Two reviewers independently screened and extracted data through Covidence and the quality was evaluated using Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted to quantify within group change and comparative effectiveness. Five hundred and seventy-four studies were identified, and 7 studies included (n = 352 participants). PARTICIPANTS This study included Type 2 diabetic adults (>18 years) diagnosed with primary or secondary adhesive capsulitis. INTERVENTIONS This review and meta-analysis included studies comparing extracorporeal shock wave therapy with conservative management. MAIN OUTCOMES The primary outcome was pain. Secondary outcomes included range of movement and disability. RESULTS Meta-analysis using Bayesian method of within group change showed consistent improvement for pain (-5.7 [95% CrI = -7 to -4.5] cm), range of movement (2.6 [95% CrI = 1.4 to 3.8]), and disability (3.6 [95% credible interval = 2.3 to 4.9]). Consistent evidence of improvements favoring extracorporeal shock wave therapy over conservative management was identified for all outcomes. Study heterogeneity had limited influence on non-controlled effect sizes, whereas limited controlled effect sizes lowered the confidence for outcomes of range of movement and disability. Limitations included low number of studies, poor methodological quality, and non-adherence to reporting guidelines. CONCLUSIONS Extracorporeal shock wave therapy for treatment of adhesive capsulitis was shown to reduce pain and improve range of motion and disability in the type 2 diabetes population. These results should be interpreted with caution and high-quality randomized controlled studies are required to establish best-practice extracorporeal shock wave therapy protocols regarding application position, dosage, and duration. RELEVANCE Extracorporeal shock wave therapy may improve pain, range of movement, and disability in Type 2 Diabetics with adhesive capsulitis.

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