Adhesive Capsulitis, Adhesive Capsulitis of the Shoulder, Exercise, Frozen Shoulder, Hormone Replacement Therapy, Post-Menopausal, Physical Therapy
Conditions
Keywords
Frozen Shoulder, Adhesive Capsulitis, Hormone Replacement Therapy, Postmenopause, Physical Therapy, Rehabilitation, Pain Catastrophizing, Range of Motion
Brief summary
The purpose of this study is to compare the effects of a physiotherapy program on pain levels, shoulder range of motion, functional status, pain catastrophizing, perceived change, sleep quality, and quality of life in postmenopausal women diagnosed with frozen shoulder, with and without Hormone Replacement Therapy (HRT). The findings are expected to contribute to personalized treatment planning for postmenopausal women with frozen shoulder and help fill the gap in current literature.
Detailed description
This study investigates the impact of Hormone Replacement Therapy (HRT) on treatment outcomes in postmenopausal women undergoing a standardized physiotherapy program for frozen shoulder (adhesive capsulitis). Participants are divided into two groups based on their current HRT status: postmenopausal women receiving HRT and those not receiving HRT. Both groups participate in the same structured physiotherapy program. Assessments are conducted at baseline and after the intervention using the following outcome measures: Primary Outcome Measures: Pain intensity evaluated by the Numeric Pain Rating Scale (NPRS) and shoulder pain and disability evaluated by the Shoulder Pain and Disability Index (SPADI). Secondary Outcome Measures: Shoulder Range of Motion (ROM) measured by goniometry, sleep quality assessed via the Pittsburgh Sleep Quality Index (PSQI), menopause-specific quality of life measured by the Menopause-Specific Quality of Life Questionnaire (MENQOL), cognitive response to pain evaluated by the Pain Catastrophizing Scale (PCS), and overall treatment perception evaluated by the Global Rating of Change (GROC) scale. By comparing these parameters, the study aims to elucidate whether systemic HRT modulates pain perception, functional recovery, and general quality of life during physical rehabilitation in postmenopausal women with frozen shoulder.
Interventions
PROCEDUREStandardized Physiotherapy Program
A standardized and supervised shoulder physical therapy and rehabilitation program delivered face-to-face in a clinical setting by an expert physiotherapist over 12 weeks (2 sessions per week, 50-60 minutes per session), supplemented by a prescribed home exercise program. The program includes patient education, stretching exercises, active-assisted and active range of motion (ROM) exercises, glenohumeral and scapular mobilization, progressive strengthening exercises, and post-treatment cryotherapy. Exercise progression is individualized based on participants' demographic characteristics, pain levels, progressive overload principles, and subjective feedback. Following each session, participants are routinely monitored for any exercise-related adverse effects.
Sponsors
Istanbul University - Cerrahpasa
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Postmenopausal female patients aged 40 to 60 years. * Shoulder pain at rest and during activities of daily living lasting for more than 3 months. * Clinical diagnosis of Stage I or Stage II frozen shoulder (adhesive capsulitis). * Passive range of motion (ROM) loss of greater than 25% compared to the unaffected shoulder in at least two movement planes (flexion, abduction, internal rotation, or external rotation). * Reduced range of motion of less than 50% compared to the unaffected side in at least one movement direction (flexion, abduction, internal rotation, or external rotation). * Increased restriction of external and internal rotation during glenohumeral abduction from 45 to 90 degrees.
Exclusion criteria
* Passive external rotation range of motion of less than 30 degrees (\<30°). * Presence of glenohumeral arthritis confirmed by radiography. * History or presence of inflammatory joint disease. * History of malignancy or active cancer diagnosis. * Previous treatment for the current shoulder condition (e.g., physiotherapy and rehabilitation, intra-articular injections, or surgical intervention). * Baseline shoulder pain score of less than 3 (\<3) on the Numeric Pain Rating Scale (NPRS).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in Shoulder Function and Disability Scores using Shoulder Pain and Disability Index (SPADI) | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Shoulder pain and disability will be assessed using the Turkish version of the Shoulder Pain and Disability Index (SPADI). The index consists of 13 items divided into two subscales: pain (5 items) and disability (8 items). Each item is scored on a 0-10 numerical rating scale. For the pain subscale, 0 indicates "no pain" and 10 indicates "worst imaginable pain". For the disability subscale, 0 indicates "no difficulty" and 10 indicates "so difficult that help is required". Subscale scores and total SPADI scores are calculated, ranging from 0 to 100, where higher scores indicate greater pain severity and functional disability. |
| Change from Baseline in Shoulder Pain Intensity Scores using Numeric Pain Rating Scale (NPRS) | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Shoulder pain intensity will be assessed using the 11-point Numeric Pain Rating Scale (NPRS), where 0 represents "no pain" and 10 represents "worst imaginable pain". Participants will rate their pain levels separately at rest and during movement. Higher scores indicate greater pain severity. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from Baseline in Active and Passive Shoulder Range of Motion (ROM) | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Active and passive shoulder range of motion (flexion, abduction, internal rotation, and external rotation) will be assessed in degrees using a universal goniometer according to standardized goniometric measurement protocols. Higher degree values indicate better mobility. |
| Change from Baseline in Menopause-Specific Quality of Life Questionnaire (MENQOL) Scores | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Health-related quality of life will be evaluated using the Menopause-Specific Quality of Life Questionnaire (MENQOL). The questionnaire consists of 29 items divided into four domains: Vasomotor (3 items), Psychosocial (7 items), Physical (16 items), and Sexual (3 items). Items are scored on a 7-point Likert scale ranging from 0 (not at all bothered) to 6 (extremely bothered). Domain scores and total scores are calculated, with higher scores indicating a greater impact of menopausal symptoms and lower quality of life. |
| Change from Baseline in Pain Catastrophizing Scale (PCS) Scores | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Pain-related catastrophizing thoughts and behaviors will be evaluated using the Pain Catastrophizing Scale (PCS). The 13-item self-report questionnaire assesses three dimensions: Rumination (4 items), Magnification (3 items), and Helplessness (6 items). Items are rated on a 5-point Likert scale ranging from 0 ("not at all") to 4 ("all the time"). Total scores range from 0 to 52, with higher scores indicating higher levels of pain catastrophizing. |
| Overall Patient-Perceived Improvement Measured by 5-Point Global Rating of Change (GROC) Scale | Week 6, Week 12, and 3-month follow-up (Week 24) | Participants' overall perception of improvement or worsening in their shoulder condition will be assessed using a 5-point Global Rating of Change (GROC) scale. The scale ranges from 1 ("much worse") to 3 ("no change") to 5 ("much better"). Higher scores indicate greater perceived overall improvement in shoulder function and symptoms. |
| Change from Baseline in Pittsburgh Sleep Quality Index (PSQI) Scores | Baseline, Week 6, Week 12, and 3-month follow-up (Week 24) | Sleep quality and disturbances over the past month will be evaluated using the Pittsburgh Sleep Quality Index (PSQI). The 19-item self-report questionnaire generates seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored from 0 to 3, yielding a global score ranging from 0 to 21. Higher global scores indicate poorer sleep quality, with a total score greater than 5 indicating poor sleep quality. |
Countries
Turkey (Türkiye)
Contacts
CONTACTŞükran Acar, Master of Science Candidate
CONTACTDerya Çelik, Prof. Dr.
STUDY_DIRECTORDERYA ÇELİK, PROF.DR.
Istanbul University - Cerrahpasa
Outcome results
None listed