Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post-operative protocols for UK FROST and inferences for wider practice

Nigel Hanchard, Lorna M. Goodchild, Stephen D. Brealey, Amar Rangan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives

The United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post-operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility.
Methods

We screened a UK Department of Health systematic review and UK evidence-based guidelines [1], [2] for recommendations, and previous surveys of UK physiotherapists [3], [4] for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post-operative physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder). We proposed respectively mandating or recommending interventions with 100% and 90% positive consensus, and respectively disallowing or discouraging interventions with 90% and 80% negative consensus. Other interventions would be optional.
Results

The systematic review and guideline recommended including steroid injection and manual mobilizations in non-operative care, and we mandated these for stand-alone physiotherapy. Consensus in the pre-existing surveys strongly favoured advice, education and home exercises, which we mandated across contexts. The Delphi survey led to recommendation of some supervised exercise modalities, plus the disallowing or discouragement—in various contexts—of immobilization and some ‘higher-tech’ electrotherapies and alternative therapies.
Conclusions

We developed physiotherapy protocols despite incomplete empirical evidence. Their clear structure enabled implementation in data-sheets designed to facilitate recording, monitoring of fidelity and reporting of interventions. Other trials involving physiotherapy may benefit from this approach.
Original languageEnglish
JournalPhysiotherapy
Early online date19 Jul 2019
DOIs
Publication statusE-pub ahead of print - 19 Jul 2019

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Bursitis
Secondary Care
Physical Therapists
Guidelines
Exercise
Electric Stimulation Therapy
Operative Surgical Procedures
National Health Programs
Complementary Therapies
Immobilization
Uncertainty
Rehabilitation
Steroids
Surveys and Questionnaires
United Kingdom
Education
Injections
Health

Cite this

@article{a989d33933fc4a5d97bc0eac84b15a86,
title = "Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post-operative protocols for UK FROST and inferences for wider practice",
abstract = "ObjectivesThe United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post-operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility.MethodsWe screened a UK Department of Health systematic review and UK evidence-based guidelines [1], [2] for recommendations, and previous surveys of UK physiotherapists [3], [4] for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post-operative physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder). We proposed respectively mandating or recommending interventions with 100{\%} and 90{\%} positive consensus, and respectively disallowing or discouraging interventions with 90{\%} and 80{\%} negative consensus. Other interventions would be optional.ResultsThe systematic review and guideline recommended including steroid injection and manual mobilizations in non-operative care, and we mandated these for stand-alone physiotherapy. Consensus in the pre-existing surveys strongly favoured advice, education and home exercises, which we mandated across contexts. The Delphi survey led to recommendation of some supervised exercise modalities, plus the disallowing or discouragement—in various contexts—of immobilization and some ‘higher-tech’ electrotherapies and alternative therapies.ConclusionsWe developed physiotherapy protocols despite incomplete empirical evidence. Their clear structure enabled implementation in data-sheets designed to facilitate recording, monitoring of fidelity and reporting of interventions. Other trials involving physiotherapy may benefit from this approach.",
author = "Nigel Hanchard and Goodchild, {Lorna M.} and Brealey, {Stephen D.} and Amar Rangan",
year = "2019",
month = "7",
day = "19",
doi = "10.1016/j.physio.2019.07.004",
language = "English",
journal = "Physiotherapy",
issn = "0031-9406",
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Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post-operative protocols for UK FROST and inferences for wider practice. / Hanchard, Nigel; Goodchild, Lorna M.; Brealey, Stephen D.; Rangan, Amar.

In: Physiotherapy, 19.07.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post-operative protocols for UK FROST and inferences for wider practice

AU - Hanchard, Nigel

AU - Goodchild, Lorna M.

AU - Brealey, Stephen D.

AU - Rangan, Amar

PY - 2019/7/19

Y1 - 2019/7/19

N2 - ObjectivesThe United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post-operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility.MethodsWe screened a UK Department of Health systematic review and UK evidence-based guidelines [1], [2] for recommendations, and previous surveys of UK physiotherapists [3], [4] for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post-operative physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder). We proposed respectively mandating or recommending interventions with 100% and 90% positive consensus, and respectively disallowing or discouraging interventions with 90% and 80% negative consensus. Other interventions would be optional.ResultsThe systematic review and guideline recommended including steroid injection and manual mobilizations in non-operative care, and we mandated these for stand-alone physiotherapy. Consensus in the pre-existing surveys strongly favoured advice, education and home exercises, which we mandated across contexts. The Delphi survey led to recommendation of some supervised exercise modalities, plus the disallowing or discouragement—in various contexts—of immobilization and some ‘higher-tech’ electrotherapies and alternative therapies.ConclusionsWe developed physiotherapy protocols despite incomplete empirical evidence. Their clear structure enabled implementation in data-sheets designed to facilitate recording, monitoring of fidelity and reporting of interventions. Other trials involving physiotherapy may benefit from this approach.

AB - ObjectivesThe United Kingdom Frozen Shoulder Trial (UK FROST) compares stand-alone physiotherapy and two operative procedures, both with post-operative rehabilitation, for primary frozen shoulder in secondary care. We developed physiotherapy protocols for UK FROST, incorporating best evidence but recognizing uncertainty and allowing flexibility.MethodsWe screened a UK Department of Health systematic review and UK evidence-based guidelines [1], [2] for recommendations, and previous surveys of UK physiotherapists [3], [4] for strong consensus. We conducted a two-stage, questionnaire-based, modified Delphi survey of shoulder specialist physiotherapists in the UK National Health Service. This required positive, negative or neutral ratings of possible interventions in four clinical contexts (stand-alone physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder; and post-operative physiotherapy for, respectively, predominantly painful and predominantly stiff frozen shoulder). We proposed respectively mandating or recommending interventions with 100% and 90% positive consensus, and respectively disallowing or discouraging interventions with 90% and 80% negative consensus. Other interventions would be optional.ResultsThe systematic review and guideline recommended including steroid injection and manual mobilizations in non-operative care, and we mandated these for stand-alone physiotherapy. Consensus in the pre-existing surveys strongly favoured advice, education and home exercises, which we mandated across contexts. The Delphi survey led to recommendation of some supervised exercise modalities, plus the disallowing or discouragement—in various contexts—of immobilization and some ‘higher-tech’ electrotherapies and alternative therapies.ConclusionsWe developed physiotherapy protocols despite incomplete empirical evidence. Their clear structure enabled implementation in data-sheets designed to facilitate recording, monitoring of fidelity and reporting of interventions. Other trials involving physiotherapy may benefit from this approach.

U2 - 10.1016/j.physio.2019.07.004

DO - 10.1016/j.physio.2019.07.004

M3 - Article

JO - Physiotherapy

JF - Physiotherapy

SN - 0031-9406

ER -