Journal Article

Rehabilitation in subjects with frozen shoulder: a survey of current (2023) clinical practice of Italian physiotherapists

Pellicciari, Leonardo, Venturin, Davide, Brindisino, Fabrizio, Andriesse, Arianna, Crestani, Mauro, Assenza, Raffaele, Salomon, Mattia, Girardi, Giuseppe, Giovannico, Giuseppe

2024

Overview

Objective Frozen Shoulder (FS) is a musculoskeletal pathology that leads to disability, functional decline, and a worsening in quality of life. Physiotherapists are the primary professionals involved in the treatment of FS, and it is essential to determine if their practice aligns with evidence-based suggestions. Aim The aim is to assess the knowledge, skills, and operational strategies of Italian physiotherapists regarding FS and compare them with the existing literature. Methods A web-based, anonymous, and voluntary cross-sectional survey was developed and administered to Italian physiotherapists to evaluate their clinical practices. Results A total of 501 physiotherapists (38.5% female), completed the survey. More than half were under 35 years old (67.8%), declared working in private practice settings or being self-employed (57.1%), and were primarily engaged with musculoskeletal patients (81.8%). For subjects with FS at their first access, 21.4% identified X-rays as the most useful imaging technique to recognize pathologies beyond rehabilitation competence. In terms of general management, the majority reported working with an orthopaedic or physiatrist (47.5%) or in a multidisciplinary team (33.5%). Regarding manual therapy techniques, 63.3% of physiotherapists preferred intense degree mobilization, posterior direction, and moderate pain at the end of the range of motion for low irritable/high stiffness FS; however, there is a lack of consensus for managing very irritable/low stiffness FS. The majority of physiotherapists (57.7%) concurred that stretching improves the balance between metalloproteinase and its inhibitors. Additionally, 48.3% of physiotherapists selected mobile phone videos and messages to improve patients’ compliance with exercises at home and for motivational/educational purposes. Discussion and Conclusion The clinical practices of Italian physiotherapists in FS subjects sometimes deviate from evidence-based recommendations. While some discrepancies may be attributed to the existing uncertainties in the literature regarding knowledge and management strategies for FS patients, the authors recommend a stronger adherence to evidence-based practice. Implications of Physiotherapy Practice Italian PTs’ clinical practices in FS rehabilitation show partial alignment with evidence-based recommendations, particularly in the areas of diagnostic imaging suggestions and clinical assessment. Italian PTs’ clinical practices exhibit partial adherence to evidence-based suggestions regarding the identification of predisposing factors, staging education, and mobilization modalities in FS cases. Italian PTs with Orthopaedic Manipulative Physical Therapists (OMPT) certification, those possessing clinical experience ranging from 6 to 10 years, and individuals working in private practice demonstrate greater appropriateness in terms of knowledge, competence, and adherence to evidence-based clinical practices for FS rehabilitation.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adhesive Capsulitis / Adult / Bursitis / Bursitis - rehabilitation / Bursitis - therapy / Care and treatment / Clinical Competence / Clinical medicine / Comorbidity / Consent / Cross-Sectional Studies / Data analysis / Data collection / Diagnosis / Education / Epidemiology / Evidence-based medicine / Evidence-based practice / Female / Frozen Shoulder / Health Knowledge, Attitudes, Practice / Humans / Internal Medicine / Italy / Joint diseases / Male / Manipulative therapy / Medicine / Medicine & Public Health / Metalloproteinase / Methods / Middle Aged / Musculoskeletal rehabilitation and physiotherapy / Orthopedics / Patient outcomes / Patients / Physical Therapists / Physical therapy / Physical Therapy Modalities / Physiotherapy / Professionals / Quality of life / Questionnaires / Rehabilitation / Rheumatology / Shoulder / Shoulder Pain / Social networks / Specialization / Sports Medicine / Statistical analysis / Strategic planning (Business) / Surveys / Surveys and Questionnaires / Therapeutics, Physiological