Shoulder joint mobility in patients with primary adhesive capsulitis after treatment with continuous mode of ultrasound: A systematic review of randomized controlled trials

Background: Although the continuous mode of ultrasound therapy improves joint mobility, its role in primary adhesive capsulitis (AC) remains unclear. Therefore, this systematic review aims to address this evidence gap. Methods: The literature search included databases (SCOPUS, CINAHL, EMBASE, and PubMed) and in-text references of articles read full-text. Randomized controlled trials (RCT) on primary AC patients (published in the English language between 1979-2019) comparing the ROM changes (in degrees) mainly between continuous mode of US therapy with any other non-electrotherapeutic treatment were eligible for inclusion. The trials were reviewed narratively along with an assessment of the risk of bias. Results: Out of 174 search results, two eligible single-center trials comprising of 100 participants compared ROM in four separate directions at the 10th session and after three months post-intervention. The risk of selection bias, performance bias, and attrition bias was unclear among the trials. While in both the trials ROM (in all directions) improved in the respective intervention groups at follow up, most of these changes varied between the intervention groups in one trial. However, in the latter trial, participants in the treatment group had the worst ROM values at baseline with poor compliance to the adjunct exercise therapy. Conclusion: The contemporary evidence in the context remains inconclusive due to a lack of large multicentric well-conducted RCTs.