Extracorporeal Shock Wave Therapy for Chronic Adhesive Capsulitis in Type 2 Diabetics: A Systematic Review With Meta-Analysis

ABSTRACT Objective The objective of this study was to assess the effectiveness of extracorporeal shock wave therapy (ESWT) in the treatment of chronic adhesive capsulitis (AC) in the type 2 diabetes population. Design 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 gray 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). Participants This study included type 2 diabetic adults (>18 years) diagnosed with primary or secondary AC. Interventions This review and meta-analysis included studies comparing ESWT with conservative management. Main outcomes The primary outcome was pain. Secondary outcomes included range of movement (ROM) and disability. Results Meta-analysis using Bayesian method of within group change showed consistent improvement for pain (−5.7 [95% credible interval (CrI) = −7 to −4.5] cm), ROM (2.6 [95% CrI = 1.4 – 3.8]), and disability (3.6 [95% CrI = 2.3–4.9]). Consistent evidence of improvements favoring ESWT 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 ROM and disability. Limitations included low number of studies, poor methodological quality, and non-adherence to reporting guidelines. Conclusions Extracorporeal shock wave therapy for treatment of AC 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 ESWT protocols regarding application position, dosage, and duration. Relevance Extracorporeal shock wave therapy may improve pain, ROM, and disability in type 2 diabetics with AC.