THE CLINICAL RESULTS OF COMBINATION OF ANXIOLYSIS, SUPRASCAPULAR NERVE BLOCK, CORTICOSTEROID INJECTION AND PHYSIOTHERAPY ON SUBJECTS WITH FROZEN SHOULDER: A RETROSPECTIVE STUDY

Autori

Martino Gabriele (University of Molise, Campobasso, Italy)

Venturin Davide (University of Molise, Campobasso, Italy)

Pellicciari Leonardo (IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy)

Casagrande Lucia (Azienda ULSS 2, Marca trevigiana, Treviso, Italy)

Brindisino Fabrizio (University of Molise, Campobasso, Italy)

Poser Antonio (University of Siena, Siena, Italy)

Background and aims

Frozen shoulder (FS) is a gleno-humeral pathology characterized by an insidious onset, increasing pain and loss of active and passive range of motion. The restriction of mobility is related to modification of collagen, overexpression of proteins and to presence of muscle guarding. The presence of muscle guarding and pain could reduce the efficacy of the physiotherapy, the adherence to the treatment and could increase emotional commitment during rehabilitation. The aim of this study was to evaluate the clinical results of a combined treatment of anxiolysis and SupraScapular Nerve Block (SSNB) with intra-articular corticosteroid injection and physiotherapy in subjects with FS.

Methods

29 subjects received SSNB, intra-articular corticosteroid injections, and intravenous anxiolysis, followed 30 minutes later by physiotherapy involving end-range, high-grade, and painful glenohumeral mobilizations, repeated throughout the first month. Participants were also instructed to perform 5 home stretching exercises for three months. Outcomes—pROM, SF-36 (and subscores), DASH, and SPADI—were assessed at baseline (T0), day 10 (T1), and 3-month follow-up (T5).

Results

SPADI and DASH scores showed significant improvement from T1 (p = .000), maintained through T5 (Table 1-2). SF-36 subscales for Physical Functioning, Physical Role, and Emotional Role reached statistical significance at T3 (p = .007; .000; .034), T4 (.001; .000; .003), and T5 (.001; .000; .004). Bodily Pain and Social Functioning showed improvements from T2 (p = .003; .043) through T5 (.000; .000). Vitality and Mental Health were significant at T4 (.017; .007) and T5 (.000; .001) (Table 3). All average pROM scores improved significantly from T1 to T5, with clinically relevant gains in flexion, abduction, and external rotation at both 90° and 0° of abduction compared to T0 (Table 4).

Conclusion

The combination of anxiolysis, injection and SSNB could have been useful to create a therapeutic window in the first session, during which painful mobilization and stretching techniques could be applied more successfully and to allow a quicker recovery in the short term, orienting through a multi-professional path of care would be helpful for subjects with FS. Anxiolysis, SSNB, and intra-articular corticosteroid injections, combined with a detailed rehabilitation techniques and a simple home exercise program, were effective in improving shoulder pain, range of motion, and disability in the short term.

REFERENCES

1- Lewis J. Frozen shoulder contracture syndrome – Aetiology, diagnosis and management. Man Ther. 2015
Feb 1;20(1):2–9.

2- Hollmann L, Halaki M, Kamper SJ, Haber M, Ginn KA. Does muscle guarding play a role in range of motion loss in patients with frozenshoulder? Musculoskelet Sci Pract. 2018 Oct 1;37:64–68.

3- Venturin D, Brindisino F, Ristori D, et al. The use of corticosteroid/anesthetic injections in conjunction with physical therapy in the treatment of idiopathic frozen shoulder: a case series. JOSPT Cases. 2021;1(4):248–265.

Is disability associated with pain, range of motion, and health-related quality of life in subjects with frozen shoulder? A Cross-sectional study

Autori

Poser Antonio (Kinè s.r.l, Viale della Quercia 2/B, Treviso, Italy – University of Siena c/o via Banchi di Sotto, 55, Siena, Italy)

Brindisino Fabrizio (Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise)

Lot Sebastiano (Physiotherapy private practice Kinè c/o Viale Venezia 13/Q San Vendemiano, Italy)

Andriesse Arianna (Medical Translation Private Practice c/o Andriesse Medical Translator, Lecce, Italy)

Rossi Alex (Kinè s.r.l, Viale della Quercia 2/B, Treviso, Italy – Tor Vergata University Via Columbia,2 00133 Rome, Italy)

Feller Daniel (Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy – Centre of Higher Education for Health Sciences of Trento, Trento, Italy – Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands)

Germano Guerra (Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise)

Venturin Davide ((Kinè s.r.l, Viale della Quercia 2/B, Treviso, Italy – University of Siena c/o via Banchi di Sotto, 55, Siena, Italy – Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise- Tor Vergata University Via Columbia,2 00133 Rome, Italy)

Introduction to clinical case

Frozen shoulder (FS) is a disabling condition characterized by pain and restricted shoulder range of motion (ROM), impacting daily activities and quality of life. While physical impairments are well-recognized contributors to disability, recent evidence highlights the role of psychosocial factors. This cross-sectional study aimed to investigate whether disability in FS patients is associated with pain, ROM limitation (specifically flexion and external rotation), and mental health-related quality of life aspects, as assessed through Patient-Reported Outcome Measures (PROMs).

Methods

A total of 123 individuals with clinically diagnosed FS were recruited from physiotherapy clinics in Italy. Passive ROM of shoulder flexion and external rotation were measured, and participants completed the DASH, SPADI (pain subscale), and SF-36 questionnaires (Vitality, Emotional Health, Mental Health, and Social Functioning subscores). A multivariable linear regression model was used to identify associations with disability (DASH score), adjusting for potential confounders (age, gender, limb dominance, and endocrine-metabolic conditions).

Results

Significant associations with disability were found for SPADI-pain (standardized coefficient = 8.83, p < 0.01), SF-36 Vitality (standardized coefficient = –3.43, p = 0.04), and shoulder flexion ROM (standardized coefficient = –3.34, p = 0.01). No significant associations emerged for external rotation ROM, Emotional Health, Mental Health, or Social Functioning.

Discussion and clinical relevance

Pain, reduced flexion ROM, and perceived vitality are key contributors to self-reported disability in FS. While ROM recovery strategies should focus on improving flexion, the inclusion of PROMs such as vitality may support a more comprehensive, biopsychosocial assessment. These findings highlight the multifactorial nature of FS-related disability and support the integration of psychological and physical health variables into treatment planning.

REFERENCES

1- Brindisino F., Silvestri E., Gallo C., Venturin D., Di Giacomo G., Peebles A. M., Provencher M. T., Innocenti T. 2022. Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation, 4(3), e1219–e1234.

3- Mertens M. G., Struyf F., Verborgt O., Dueñas L., Balasch-Bernat M., Navarro-Ledesma S., Fernandez-Sanchez M., Luque-Suarez A., Lluch Girbes E., Meeus M. 2023. Exploration of the clinical course and longitudinal correlations in frozen shoulder: The role of autonomic function, central pain processing, and psychological variables. A longitudinal multicenter prospective observational study. Musculoskeletal Science and Practice, 67, 102857.

2- De Cristofaro L., Brindisino F., Venturin D., Andriesse A., Pellicciari L., Poser A. 2024. Prognostic factors of nonsurgical intervention outcomes for patients with frozen shoulder: a retrospective study. Disability and Rehabilitation, 0(0), 1–8.

Is artificial intelligence reliable in assessing the internal validity of the randomized controlled trial in physiotherapy? A cross-sectional study

Autori

Giacomo Perugino – (Program in Physical Therapy, University of Florence, Florence, Italy)

Camilla De Pedrini – (UniCamillus, International Medical University in Rome, Rome, Italy)

Daniele Piscitelli – (School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy)

Alessandro Ugolini – (Independent researcher, Empoli (FI), Italy)

Alessandra Carlizza – (UniCamillus, International Medical University in Rome, Rome, Italy)

Leonardo Pellicciari (IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy)

Background and aims

Artificial intelligence (AI) is defined as the ability of computer systems to perform tasks that would traditionally require human intelligence. Its application is widespread in physiotherapy science, supporting procedures such as gait analysis and diagnostic image interpretation.

A crucial aspect of the critical appraisal in the evidence-based practice is assessing the internal validity of randomized clinical trials (RCTs) to ensure the reliability of results. Among instruments assessing the internal validity, the PEDro scale is used to evaluate the internal validity of RCTs.

This study aims to evaluate the reliability and agreement of ChatGPT (i.e., a generative AI) in assigning the PEDro score by comparing AI-generated scores with human scores.

Methods

This study aims to evaluate the reliability and agreement of ChatGPT (i.e., a generative AI) in assigning the PEDro score by comparing AI-generated scores with human scores.

Results

1755 RCTs were included. The percentage of agreement ranged between 67.8% (Item#3) and 96.9% (Item#2 and Item#10). The k values were below 0.450, indicating slight to moderate reliability; however, these findings are influenced by the k paradox (i.e., higher percentage of agreement but lower k, consequent to the heterogeneity in the rating). P++ findings showed that the two assessors attributed few simultaneous “yes” responses, while the SA indicates that the concordance is mainly reported in “yes” responses, while the SD showed that one evaluator tends to say “yes” more than the other. Finally, the ICC for the total score indicates poor inter-rater reliability. Similar recurrent result patterns are reported for the analyses of the subcategories.

Conclusion

Our results show variability in agreement between ChatGPT and human reviewers depending on the items considered. Items with high agreement are related to the presence in the full texts of keywords recognizable by AI, while more complex items that require cognitive reasoning (i.e., Item#9). To date, ChatGPT could be used as a preliminary screening tool to assess certain PEDro items, but it cannot replace human assessment.

REFERENCES

Cashin AG, McAuley JH. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. J Physiother. 2020 Jan;66(1):59. doi: 10.1016/j.jphys.2019.08.005.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003 Aug;83(8):713-21.