No abstract

BackgroundSeveral systematic reviews (SRs) assessing the effectiveness of superficial physical agents have been published, but the evidence about their safety remains controversial.ObjectiveTo identify areas where there is evidence of the safety of physical agents by a scoping review.DesignFour databases were systematically searched for including English SRs that explored and reported safety in terms of adverse events (AEs) related to the application of physical agents in outpatient and inpatient physical medicine and rehabilitation settings managed by healthcare professionals, published in January 2011–29 September 2021. The severity of AEs was classified according to the Common Terminology Criteria. Then, AE findings were summarised according to the SR syntheses. Finally, the reporting of the certainty of the evidence was mapped.ResultsOverall, 117 SRs were retrieved. Most of the SRs included randomised controlled trials (77%) and patients with musculoskeletal disorders (67%). The most investigated physical agents were extracorporeal shock wave therapy (ESWT) (15%), transcutaneous electrical nerve stimulation (13%) and electrical stimulation (12%). No AE (35%) was reported in one-third of the included primary studies in SRs, whereas few severe AEs occurred in less than 1% of the sample. Among physical agents, ESWT showed an increased risk of experiencing mild AEs compared with the control. Most SRs reported a qualitative AE synthesis (65.8%), and few reported the certainty of the evidence (17.9%), which was mainly low.ConclusionWe found evidence of safety on several physical agents coming mostly from qualitative synthesis. No significant harms of these interventions were found except for ESWT reporting mild AEs. More attention to the AEs reporting and their classification should be pursued to analyse them and assess the certainty of evidence quantitatively.Review registrationhttps://osf.io/6vx5a/.

Frozen shoulder is a common shoulder concern with a prevalence of 2-5 per cent in the general population that affects the shoulder joint between the ages of 40 and 60, mostly in female subjects, manifesting in progressive loss of glenohumeral movements associated with intense pain. The pathological process consists of a fibroproliferative tissue fibrosis and an inflammation of the synovial membrane. Although the pathophysiology of this condition has been deeply studied, the mechanisms underpinning remain poorly understood. Frozen shoulder manifests clinically as shoulder pain with progressive restricted movement, both active and passive, in the absence of trauma, along with normal radiographic scans of the glenohumeral joint. It classically progresses through 3 overlapping stages of pain (stage 1, lasting 2-9 months), stiffness (stage 2, lasting 4-12 months) and recovery (stage 3, lasting 5-24 months); however, up to day seems that pain-predominant and stiff-predominant phases could be more usefull in treatment modality choice and managing. The medical management has not been defined with a wide spectrum of operative and nonoperative treatments available. The most widely used treatments are local steroid and/or anesthetic injections, stretching, active and passive mobilization, physiotherapy, hydrodistension, capsular release; hoverver, he goals of the treatment are pain management, shoulder function restoration and improvement in quality of life. Based on the best available evidence it appears that the use of corticosteroid injections plus physiotherapy has been associated with better outcomes above all in terms of early benefit in ER ROM with clinical significance as long as 6 weeks of treatments. Nevertheless, it remains unclear which parameters influence the prognosis of the pathology. So that, the aim of this study was to investigate whether a range of motion superior to 90 degree forward flexion in scapular plane, External Rotation (ER) at arm by side ( lower than 30 per cent, between 30 and 60 per cent, 90 per cent or more than contralateral side) and abduction ( lower than 30 per cent, between 30 and 60 per cent, 90 per cent or more than contralateral side) at baseline would predict best treatment outcome as measured by SPADI, NRS for Pain (night, at rest and in activity) and change in ROM in patients diagnosed with frozen shoulder