Extracorporeal shock wave therapy for chronic adhesive capsulitis in type 2 diabetics: a systematic review with meta-analysis.

Reno, Crystal; Swinton, Paul A.; Alexander, Lyndsay

Abstract

The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy in the treatment of chronic adhesive capsulitis in the type 2 diabetes population. This study is a systematic review with meta-analysis. The search was conducted in MEDLINE, EMBASE, CINAHL, PEDro, Cochrane Database of Systematic Reviews, UK Clinical Trial Gateway and grey literature from 2012 to 2023. Two reviewers independently screened and extracted data through Covidence and the quality was evaluated using Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted to quantify within group change and comparative effectiveness. Five hundred and seventy-four studies were identified, and 7 studies included (n = 352 participants). This study included Type 2 diabetic adults (>18years) diagnosed with primary or secondary adhesive capsulitis. This review and meta-analysis included studies comparing extracorporeal shock wave therapy with conservative management. The primary outcome was pain. Secondary outcomes included range of movement and disability. Meta-analysis using Bayesian method of within group change showed consistent improvement for pain (-5.7 [95% CrI = -7 to -4.5] cm), range of movement (2.6 [95% CrI = 1.4 to 3.8]), and disability (3.6 [95% credible interval = 2.3 to 4.9]). Consistent evidence of improvements favoring extracorporeal shock wave therapy over conservative management was identified for all outcomes. Study heterogeneity had limited influence on non-controlled effect sizes, whereas limited controlled effect sizes lowered the confidence for outcomes of range of movement and disability. Limitations included low number of studies, poor methodological quality, and non-adherence to reporting guidelines. Extracorporeal shock wave therapy for treatment of adhesive capsulitis was shown to reduce pain and improve range of motion and disability in the type 2 diabetes population. These results should be interpreted with caution and high-quality randomized controlled studies are required to establish best-practice extracorporeal shock wave therapy protocols regarding application position, dosage, and duration. Extracorporeal shock wave therapy may improve pain, range of movement, and disability in Type 2 Diabetics with adhesive capsulitis.

Citation

RENO, C., SWINTON, P.A. and ALEXANDER, L. 2025. Extracorporeal shock wave therapy for chronic adhesive capsulitis in type 2 diabetics: a systematic review with meta-analysis. Physical therapy and rehabilitation journal [online], 105(7), article number pzaf074. Available from: https://doi.org/10.1093/ptj/pzaf074

• Journal Article Type: Review
• Acceptance Date: Feb 25, 2025
• Online Publication Date: May 22, 2025
• Publication Date: Jul 31, 2025
• Deposit Date: Feb 27, 2025
• Publicly Available Date: May 23, 2026
• Journal: Physical therapy and rehabilitation journal
• Print ISSN: 0031-9023
• Electronic ISSN: 1538-6724
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 105
• Issue: 7
• Article Number: pzaf074
• DOI: https://doi.org/10.1093/ptj/pzaf074
• Keywords: Extracorporeal shock wave therapy; Adhesive capsulitis; Frozen shoulder; Physical therapy; Review; Meta-analysis
• Public URL: https://rgu-repository.worktribe.com/output/2715537
• Related Public URLs: https://rgu-repository.worktribe.com/output/2715566 (PROSPERO protocol)
• Additional Information: This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.