Efficacy of physiotherapy after hydrodilatation for the painful stiff shoulder: a randomised placebo-controlled trial

肩部疾病很常见，仅次于背部和颈部疾病，是求医的肌肉骨骼原因，占所有物理治疗转介的10%。僵硬的肩痛影响了高达2%-5%的普通人群，在中年和糖尿病患者中更为常见。它造成严重的疼痛和残疾，限制了日常生活以及工作和休闲活动。40%的患者将在3年后继续出现症状和行动受限，15%的患者将持续残疾。由于这种疾病很流行，它给澳大利亚的医疗保健系统带来了相当大的负担。肩部积水扩张术是一种常见的保守治疗方法，我们的研究小组已经证明，这种方法有短期疗效，但没有长期疗效。在水扩张后可以开出理疗处方，因为它可以保持水扩张的最初益处。然而，目前还没有研究支持或驳斥这一假设。因此，这一新颖的研究项目将回答有关除了水扩张治疗僵硬疼痛的肩部外，物理治疗计划的有效性的重要问题。我们将确定物理治疗是否比单纯的水扩张有好处，如果是，这种好处是否持续。此外，我们将确定物理治疗的额外费用是否物有所值。然后，这个项目的结果可以很容易地立即转化为临床实践，因为可以就物理治疗对这一患者群体的有用性提出建议。这项研究结果不但对物理治疗专业有重大裨益，而且对医疗专业亦有重大裨益，他们必须证明病人转介至物理治疗是合理的。

Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and they account for 10% of all physiotherapy referrals. The stiff painful shoulder affects up to 2-5% of the general population, being more common in middle age and diabetes. It causes significant pain and disability that restricts activities of daily living as well as work and leisure. Forty percent of sufferers will continue to have symptoms and restricted movements beyond 3 years and 15% will have persistent disability. Because this disease is prevalent, it imposes a considerable burden on the Australian health care system. Shoulder hydrodilatation is a common conservative treatment option that has been shown by our research group to have short-term but not long-term benefits. Physiotherapy may be prescribed following hydrodilatation on the basis that it may maintain the initial benefits seen with hydrodilatation. However, there are no studies to either support or refute this hypothesis. Thus, this novel research project will answer important questions about the efficacy of a physiotherapy program in addition to hydrodilatation for the stiff painful shoulder. We will determine whether physiotherapy offers a benefit over hydrodilatation alone and if so, whether this benefit is sustained. In addition we will determine whether the additional costs of physiotherapy represent good value for money. The results of this project can then be easily and immediately translated into clinical practice as recommendations can be made about the usefulness of physiotherapy for this patient population. The results will be of major benefit not just to the physiotherapy profession but to the medical profession who must justify patient referral to physiotherapy.