Generating an evidence base to guide clinical practice in the management of Frozen Shoulder

This thesis describes how my clinical and research leadership supported a collaborative research endeavour resulting in the generation of good quality evidence to guide clinical practice in the management of Frozen Shoulder (also known as Adhesive Capsulitis). Frozen shoulder is a disabling condition that makes the shoulder very painful, tight, and stiff. People with the condition may struggle with basic daily activities and have sleep disturbance. The estimated cumulative incidence of Frozen Shoulder is 2.4 per 1000 population per year, affecting around 8% of men and 10% of women of working age. There was considerable variation in treatment provision, and despite lack of good quality evidence invasive surgical treatment was being increasingly used.

The original body of work covered by the papers included in this thesis has generated new knowledge and made significant contributions to our understanding of Frozen Shoulder and its response to treatment. The methods used in the five included papers span research priority setting, identifying uncertainties, conduct of the largest randomised clinical trial to date of commonly used secondary care treatments for Frozen Shoulder (The UK FROzen Shoulder Trial or UKFROST), Delphi consensus development in standardising physiotherapy pathways for Frozen Shoulder, and a systematic review contextualising the results of UKFROST to guide clinical practice.

There was a clear need to standardise care pathways for Frozen Shoulder. The surgical treatments were not superior to the structured physiotherapy pathway that was developed and used in UKFROST. If that structured physiotherapy is provided routinely as the initial treatment, more invasive surgery can be avoided. The body of work presented in this thesis has informed national guidelines for clinical practice. It is hoped that it will help improve and standardise the care provided to individuals who develop a Frozen Shoulder and help guide future primary research on the topic.