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

肩部疾病是常见的，是第三次仅次于背部和颈部的肌肉骨骼疾病的原因，他们占所有物理治疗转诊的10%。肩关节僵硬疼痛影响高达2-5%的普通人群，在中年和糖尿病患者中更常见。它会导致严重的疼痛和残疾，限制日常生活活动以及工作和休闲。40%的患者将继续有症状和限制运动超过3年，15%将有持续的残疾。由于这种疾病很普遍，它给澳大利亚的卫生保健系统带来了相当大的负担。肩关节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它有短期而非长期的益处。物理治疗可以在水扩张后进行，因为它可以保持水扩张的最初益处。然而，没有研究支持或反驳这一假设。因此，这项新的研究项目将回答有关物理治疗计划的有效性的重要问题，除了水扩张僵硬疼痛的肩膀。我们将确定物理治疗是否比单纯水扩张术更有益，如果是，这种益处是否持续。此外，我们亦会研究物理治疗的额外费用是否物有所值。该项目的结果可以很容易地立即转化为临床实践，因为可以对该患者群体的物理治疗的有用性提出建议。结果将是重大的好处，不仅物理治疗专业，但医疗专业谁必须证明病人转介物理治疗。

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.