Abril - 2017

atient

reported

measures

quality

life

and

functional

capacity

adhesive

capsulitis

ssoc

ras

2017; 63(4):347-354

351

Before treatment, severe pain was the only independent

variable that influenced the low values in the physical

domain significantly, while younger subjects (p=0.03) and

those with less education (p=0.02) influenced the low

scores in the environmental domain. The influence of the

female gender as an independent variable (p=0.004) was

reflected in higher DASH scores.

Older patients with higher educational levels influenced

posttreatment improvement of QoL in the physical, psy-

chological and environmental domains of the WHOQOL-

-BREF and also influenced increased functional capacity of

the shoulder assessed using DASH (Table 3).

iscussion

This study confirms that adhesive capsulitis is more pre-

dominant in females in the 5

and 6

generations,

since

it is a disease commonly associated with other systemic

and non-systemic disorders

found in 65.1% of cases, of

which 11.6 % were secondary to hypothyroidism. Bilater-

al disease was one of the study’s exclusion criteria and,

thus, it was not possible to compare our data with those

in the literature, where the prevalence of bilateral disease

is reported to be between 20 and 40%.

10,14,15

The analysis of the results of disease treatment through

scales assessing range of motion and strength only provides

researchers with a single-faceted view of the patient’s health

conditions.

9,16,17

However, the progress of research on QoL

outcomes contributes to the perception of patients regard-

ing their health and life by providing a validated subjective

score of their symptoms, free frommedical bias.

1,3,4,6,14

The main objective of this study was to assess QoL and

FC in adhesive capsulitis patients using two assessment in-

struments, WHOQOL-BREF and DASH. Gupta et al. stud-

ied the impact of adhesive capsulitis in diabetic and elder-

ly patients but used the Oxford Shoulder Score and Short

Form-36 (SF-36) to do so. They concluded that adhesive

capsulitis worsened the diabetics’ quality of life.

The course of this disease is prolonged,

14,19

greatly

impairing sleep and the patients’ everyday activities and,

therefore, their physical, psychological and social QoL as

reflected in the various WHOQOL-BREF domains before

SSNB treatment. Baums et al. used the SF-36 to examine

the QoL of adhesive capsulitis patients before surgical

release and found that the physical component was con-

siderably affected.

The DASH score confirms major

functional disability caused by adhesive capsulitis in the

affected shoulder as cited in the literature.

7,9,14

SSNB is one of the treatment options for adhesive

capsulitis.

8,16

It was used alone in the present research,

on a weekly basis, with no simultaneous physiotherapy

or any other additional method. Mitra et al. used a pro-

tocol of SSNB associated with three additional proce-

dures for a synergistic therapeutic effect. Despite improve-

ment in shoulder function, the authors were unable to

say which fraction of the protocol was most effective.

Shanahan et al. carried out SSNB without the aid of a

nerve stimulator or imaging techniques, as in our study,

but used 1 mL of 40 mg methylprednisolone, associated

with bupivacaine 0.5%.

Neither Mitra nor Shanahan

assessed QoL as the outcome.

Importantly, after SSNB, mean QoL scores in all of

the WHOQOL-BREF domains increased. This means that

QoL that was low in all domains but lowest in the physi-

cal domain improved significantly after procedure. The

domain that improved the least was the social domain,

probably because adhesive capsulitis does not cause a

TABLE 2

Mean scores of WHOQOL-BREF domains, DASH and comparison between pre- and posttreatment of patients

with adhesive capsulitis using suprascapular nerve block (n=43).

Domains

Mean

Median

Physical 1

45.34

46.42

19.75

39.27-51.43

0.000**

Physical 2

67.85

12.87

63.89-71.82

Psychological 1

63.95

66.66

16.33

58.93-68.92

0.000*

Psychological 2

73.54

79.16

15.77

68.69-78.40

Social 1

68.21

66.66

19.26

62.29-74.15

0.049*

Social 2

73.83

19.29

67.90-79.77

Environment 1

60.24

62.50

15.62

55.44-65.06

0.001**

Environment 2

66.42

68.75

15.44

61.67-71.18

DASH 1

61.68

64.16

18.71

55.92-67.44

0.000**

DASH 2

42.11

38.33

18.30

36.48-47.74

*Wilcoxon test; **t-paired test; 1=before; 2=after.