Interventions Associated With an Increased or Decreased Likelihood of Pain Reduction and Improved Function in Patients With Adhesive Capsulitis:

Dianne V Jewell, Daniel L Riddle and Leroy R Thacker

DV Jewell, PT, DPT, PhD, CCS, is Assistant Professor, Department of Physical Therapy, Virginia Commonwealth University, 1200 E Broad St, Suite 100, PO Box 980224, Richmond, VA 23298-0224 (USA).
DL Riddle, PT, PhD, FAPTA, is Otto D. Payton Professor, Department of Physical Therapy, Virginia Commonwealth University.
LR Thacker, PhD, is Assistant Professor, Department of Biostatistics, Virginia Commonwealth University.

Address all correspondence to Dr Jewell at: dvjewell@vcu.edu

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.

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial

Surplus Value of Hip Adduction in Leg-Press Exercise in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial
Chen-Yi Song, Yeong-Fwu Lin, Tung-Ching Wei, Da-Hon Lin, Tzu-Yu Yen and Mei-Hwa Jan

CY Song, PT, MS, is a PhD student, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
YF Lin, MD, PhD, is Orthopedic Surgeon, Department of Orthopedics, West Garden Hospital, Taipei, Taiwan.
TC Wei, PT, MS, is Physical Therapist, Yeong-An Clinic, Taipei, Taiwan.
DH Lin, MD, is Orthopedic Surgeon, Department of Orthopedics, En Chu Kong Hospital, Taipei, Taiwan.
TY Yen, PT, MS, is Physical Therapist, Yeong-An Clinic.
MH Jan, PT, MS, is Associate Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 3F, No. 17, Xuzhou Rd, Zhongzheng District, Taipei 100, Taiwan, Republic of China.

Address all correspondence to Ms Jan at: mhjan@ntu.edu.tw

Background: A common treatment for patients with patellofemoral pain syndrome (PFPS) is strength (force-generating capacity) training of the vastus medialis oblique muscle (VMO). Hip adduction in conjunction with knee extension is commonly used in clinical practice; however, evidence supporting the efficacy of this exercise is lacking.

Objective: The objective of this study was to determine the surplus effect of hip adduction on the VMO.

Design: This study was a randomized controlled trial.

Setting: The study was conducted in a kinesiology laboratory.

Participants: Eighty-nine patients with PFPS participated.

Intervention: Participants were randomly assigned to 1 of 3 groups: hip adduction combined with leg-press exercise (LPHA group), leg-press exercise only (LP group), or no exercise (control group). Training consisted of 3 weekly sessions for 8 weeks.

Measurements: Ratings of worst pain as measured with a 100-mm visual analog scale (VAS-W), Lysholm scale scores, and measurements of VMO morphology (including cross-sectional area [CSA] and volume) were obtained before and after the intervention.

Results: Significant improvements in VAS-W ratings, Lysholm scale scores, and VMO CSA and volume were observed after the intervention in both exercise groups, but not in the control group. Significantly greater improvements for VAS-W ratings, Lysholm scale scores, and VMO volume were apparent in the LP group compared with the control group. There were no differences between the LP and LPHA groups for any measures.

Limitations: Only the VMO was examined by ultrasonography. The resistance level for hip adduction and the length of intervention period may have been inadequate to induce a training effect.

Conclusions: Similar changes in pain reduction, functional improvement, and VMO hypertrophy were observed in both exercise groups. Incorporating hip adduction with leg-press exercise had no impact on outcome in patients with PFPS.