Thirty-one studies and one economic evaluation were included. Many of the studies were at a high risk of bias.
Based on single RCTs, short-wave diathermy could be more effective than home exercise. For patients who had already had treatment in most cases, high-grade mobilisation could be more effective than low-grade mobilisation.
Data from two RCTs showed that adding a single intra-articular steroid injection to home exercise could benefit patients who had a frozen shoulder for less than six months, and adding physiotherapy (including mobilisation) to a single steroid injection could be beneficial.
The mixed-treatment comparison (nine studies) found that steroids plus physiotherapy was the only treatment that had a statistically and clinically significant benefit, compared with placebo, for short-term pain (SMD -1.58, 95% CrI -2.96 to -0.42).
No studies of patients’ views about treatments were identified.
The published economic evaluation suggested that low-grade mobilisation could be more cost-effective than high-grade mobilisation.
The cost-effectiveness analysis conducted as part of this review, suggested that steroids could be more cost-effective than steroids plus physiotherapy or physiotherapy alone, but these results were very uncertain.