Niel Asher Technique - Clinical Trials, Addenbrookes University Hospital, Cambridge, 2003
A PILOT RANDOMISED PLACEBO- CONTROLLED TRIAL OF PHYSIOTHERAPY AND OSTEOPATHIC TREATMENT FOR FROZEN SHOULDER
JT Wies¹, S Niel Asher², M Latham¹, BL Hazleman¹, CA Speed¹.
¹Rheumatology Research Unit – E6, Addenbrookes NHS Trust, Cambridge, Cambridgeshire, United Kingdom; ²The London Frozen Shoulder Clinic, London United Kingdom
Frozen shoulder is highly prevalent, affecting 5 – 10% of the population and is frequently treated by both osteopaths and physiotherapists. There is little evidence to support current modes of treatment. The purpose of this study was to assess the efficacy of physiotherapy, placebo treatment and a novel osteopathic approach to treatment of frozen shoulder.
Patients recruited for a randomised, controlled trial of treatment for frozen shoulder were assessed at the beginning and end of a twelve-week treatment period. All patients were assessed by a chartered physiotherapist blinded to treatment allocation and completed a range of outcome measures including the primary measure for this study, the Shoulder Pain and Disability Index (SPADI) – a 0 to 100 scale in which 0 represents normal. Treatment comprised either placebo (consisting of breathing exercising, efflourage massage, and pain-free range of motion exercises), physiotherapy (consisting of manual therapy and therapeutic exercise), or a novel osteopathic technique (the Niel Asher Technique, consisting of a progression of deep tissue manipulations).
The results for a group of 27 patients are presented here. Primary outcome measures were the SPADI and active shoulder abduction ROM measured via goniometer. Mean abduction improved in the Osteopathy group by 52.6° (sd=14.6), the Physiotherapy group improved 24.0° (sd=35.8) and the Placebo group improved by 0.8° (sd=39.5).) There was a significant difference between groups for this measure (p= 0.005 Kruskal-Wallis Test). Mean SPADI scores improved in the Osteopathy group 38.7 (sd=22.5), the Physiotherapy group improved by 19.9 (sd=24.6) and the Placebo group improved by 22.8 (sd=18.2). There was no significant difference between groups (p=0.187 Kruskal-Wallis Test).
Patients with frozen shoulder significant levels of impairment and associated disability. There has been little evidence to support traditional approaches to treatment of this condition. Treatment with the Niel Asher Tecnhique resulted in improved active abduction ROM however, there were no significant differences between groups for the SPADI score. All groups improved on the SPADI, supporting the notion that patients with this problem may spontaneously improve with regards to pain and disability. Range of motion did not improve for the placebo group, indicating that impairment may linger without treatment in this group of people. A larger study with higher statistical power is warranted.