Effectiveness of an Integrated Physiotherapy Approach Incorporating Advanced Electrotherapeutic Modalities Along with Exercise Intervention in Stage I–II Adhesive Capsulitis of The Shoulder: A Clinical Comparison with Conventional Physiotherapy

Abstract

Background: Adhesive capsulitis (AC), commonly known as frozen shoulder, is characterized by pain, stiffness, restricted shoulder mobility, and functional disability. Although conventional physiotherapy is widely used, there is considerable variation in treatment approaches and limited evidence regarding the comparative effectiveness of advanced physiotherapy interventions. Objective: To compare the effects of an Advanced Physiotherapy Protocol (APT) and a Conventional Physiotherapy Protocol (CPT) on pain intensity and functional disability in individuals with Stage I and II adhesive capsulitis. Methods: A retrospective comparative study was conducted using anonymised physiotherapy records from Physiotattva Physiotherapy Clinics, Bengaluru, covering March to May 2026. A total of 172 patient records meeting the study criteria were included, comprising 105 patients in the APT group and 67 in the CPT group. The APT included shockwave therapy, high-intensity laser therapy, manual and soft-tissue techniques, ergonomic training, progressive strengthening and conditioning, and technology-assisted home rehabilitation. The CPT included hot pack, transcutaneous electrical nerve stimulation, therapeutic ultrasound, interferential therapy, and standardised therapeutic exercises. Pain intensity and functional disability were assessed using the Numeric Pain Rating Scale (NPRS) and Quick-DASH Index (QDI), respectively. Within- and between-group changes were analysed using appropriate parametric statistical tests and ANCOVA, with statistical significance set at p<0.05. Results: Both groups demonstrated significant pre- to post-treatment improvements in pain and functional disability (p<0.001). Mean NPRS reduction was 4.30 in the APT group compared with 2.55 in the CPT group, with a significant between-group difference of 1.74 (p<0.001). QDI improved by 22.63 points in the APT group and 19.43 points in the CPT group; however, the between-group difference was not statistically significant. After adjustment for baseline scores using ANCOVA, post-treatment NPRS remained significantly lower in the APT group (p<0.001), whereas no significant between-group effect was observed for post-treatment QDI. Conclusion: Both physiotherapy protocols were associated with significant improvements in pain and functional disability in Stage I and II adhesive capsulitis. The Advanced Physiotherapy Protocol demonstrated a significantly greater reduction in pain intensity, while functional improvement was comparable between the two groups. These findings support the potential role of an integrated, stage-specific physiotherapy approach incorporating advanced electrotherapeutic modalities, manual therapy, and progressive exercise in the management of adhesive capsulitis.