Projects

Evidence-based physiotherapy guidelines for contracted frozen shoulder

We have developed the first ever evidence-based physiotherapy guidelines for the diagnosis, assessment and physiotherapy management of contracted frozen shoulder (CFS)—a condition which painfully restricts movement, affects up to 10% of working-age adults in a general UK population, and costs the NHS at least £13.5 million annually.

Evidence-based physiotherapy guidelines for contracted frozen shoulder

The guidelines will improve the clinical management of CFS and patients’ experiences of the condition.

Our recommendations drew on a systematic review and meta-analysis of the primary literature conducted as part of the guidelines' development. A preceding survey of UK physiotherapists (1) provided context. The guidelines were made available early in 2011, endorsed by the Chartered Society of Physiotherapy (CSP) following extensive expert and consumer peer review. They target physiotherapists and other healthcare professionals. A quick reference summary (separately published following independent peer review) maximises accessibility (2).

The guidelines' impact is already high. By July 2013 there had been 11294 downloads in the UK (20% of the membership of the CSP) of 16294 internationally. To assess the guidelines contribution to change in practice in the UK in their first 12-18 months, we conducted an online survey (Hanchard et al., at review). This revealed generally encouraging correspondence between recommendations and practice, mostly reflecting validation of responders' existing practice, but also some change in practice. Notably, a new system for classifying the stage of CFS, with important implications for the selection and timing of treatment interventions, was widely adopted. To illustrate international impact, colleagues in the Philippines have sought permission to use the guidelines as a basis for their own, locally targeted guideline.

The guidelines electronic format facilitates their continuing development, and this goes hand-in-hand with on-going work within HSCI to evaluate patients' experiences of CFS and priorities for treatment.

The Guidelines are available at: www.csp.org.uk/skipp

References

  1. Hanchard NCA, Goodchild L, Thompson J, Brien TO, Davison D, Richardson C. A questionnaire survey of UK physiotherapists on the diagnosis and management of contracted ( frozen ) shoulder. Physiotherapy [Internet]. The Chartered Society of Physiotherapy; 2011;97(2):115-25. Available from: http://dx.doi.org/10.1016/j.physio.2010.08.012
  2. Hanchard NCA, Goodchild L, Thompson J, O'Brien T, Davison D, Richardson C. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of contracted (frozen) shoulder: quick reference summary. Physiotherapy [Internet]. The Chartered Society of Physiotherapy; 2012 Jun [cited 2013 Jun 6];98(2):117-20. Available from: http://dx.doi.org/10.1016/j.physio.2012.01.001