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

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