Adhesive capsulitis: Prospective observational multi-center study on the Niel-Asher technique (NAT)

Objective: To evaluate "The Niel-Asher Technique (NAT)" for adhesive capsulitis. Method: Prospective observational multi-center study. Subjects: 154 patients (113 from Israel, 25 from the UK and 16 from the US) with pain, stiffness and globally restricted gleno-humeral mobility shoulder for more than three months. Outcome measures: Change in active range of motion (AROM) Flexion and Abduction of the gleno-humeral joint measured by a goniometer; changes in pain as evaluated by the patients on a linear Visual Analogue Scale (VAS). Analysis was based on the intention-to-treat principle. Results: Multivariate repeated measures analysis of covariance indicated that there was a significant improvement in AROM abduction and flexion across time, with no interaction between time and phase of illness (acute/stiff/resolving). The improvement in range of motion was significantly more pronounced in patients from Israel compared to the UK and US. Similarly, among patients from Israel, large and statistically significant reduction in the VAS pain score between baseline and post-treatment assessments was observed. Conclusions: All patients demonstrated a significant improvement in AROM for both flexion and abduction. The data supports the notion that NAT is autonomously reproducible. NAT demonstrated significant improvement in AROM for both flexion and abduction with a consistent average of twelve degrees improvement per treatment session. The mean number of treatments was 7. NAT expedites both pain reduction and increased mobility for adhesive capsulitis over and above the natural history. (C) 2014 Elsevier Ltd. All rights reserved.