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Randomized Controlled Trial
. 2025 May 3;26(1):146.
doi: 10.1186/s13063-025-08848-0.

Effectiveness of proprioceptive neuromuscular facilitation pattern on upper extremity and scapula in patients with adhesive capsulitis: a single-centre assessor-blinded randomised controlled trial (RCT)

Abid Hasan Khan  1 , Md Saruar Hossain Bhuiyan  2 , Md Feroz Kabir  2 , Md Zahid Hossain  2 , Sharmila Jahan  2 , K M Amran Hossain  2 , Ehsanur Rahman  3
Affiliations
Randomized Controlled Trial

Effectiveness of proprioceptive neuromuscular facilitation pattern on upper extremity and scapula in patients with adhesive capsulitis: a single-centre assessor-blinded randomised controlled trial (RCT)

Abid Hasan Khan et al. Trials. .

Abstract

Background: Adhesive capsulitis (AC) is a progressive inflammatory condition of the shoulder that causes functional limitations and leads to long-term disability. The study aimed to elicit the effectiveness of proprioceptive neuromuscular facilitation (PNF) compared to standard physiotherapy approaches on AC.

Methods: An assessor-blinded single-centre randomised control trial (RCT) was carried out on 80 AC patients between May 2022 and December 2023 in Bangladesh. Random assigned and concealed allocated patients were recruited equally (n = 40) to each PNF and conventional capsular stretching group. The experimental group received a PNF approach, and the control group received capsular stretching to the affected shoulder for 24 sessions in 6 weeks. Both groups received electrical modalities as standard treatment. The primary outcome was pain measured by the numeric pain rating scale (NPRS) and range of motion in a universal goniometer. The secondary outcome was functional limitation measured by the shoulder pain and disability index (SPADI). As per the distribution of data, non-parametric tests were employed to analyse the superiority between and within groups with intention-to-treat analysis.

Results: Baseline compatibility was noted in all the key variables (p > 0.05). Both PNF and capsular stretching had a decrease in pain compared to baseline in all capsular pattern positions (p < 0.001), and PNF had more significant improvement compared to control (p < 0.001). Both groups had equal improvement in shoulder ROM (p < 0.001) except abduction (p < 0.05). Both groups had improvements in disability (p < 0.05), and PNF had statistical superiority of improvement (p < 0.001).

Conclusions: The findings of this study support the potential of PNF intervention for 6 weeks as a treatment for shoulder adhesive capsulitis, showing improvements in pain, ROM and functional disability. However, further multicentre trials with a follow-up design are needed to fully understand the superiority of PNF on shoulder AC, encouraging continued engagement in this area of research.

Trial registration: The Australian New Zealand Clinical Trial Registry (ACTRN12621001299897). Registered on 27 September 2021, prospectively registered.

Keywords: Adhesive capsulitis; Proprioceptive neuromuscular facilitation (PNF) pattern; Standard physiotherapy; Upper extremity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Authors received the ethical permission to conduct the trial from the Institutional Review Board (IRB), Bangladesh Health Professions Institute (BHPI), Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka 1343, Bangladesh (CRP-BHPI/IRB/08/2021/676). This trial is also listed in the Australian New Zealand Clinical Trial Registry (ACTRN) (ACTRN12621001299897) which is a primary clinical trial registry of the World Health Organization (WHO). The Helsinki Declaration was followed during the study, and we obtained informed consent from all subjects and their legal guardians. Consent for publication: The participants were provided with informed consent before publishing any information. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
PNF application procedure for upper extremity (A1–A3) and scapula (B1, B2)
Fig. 3
Fig. 3
Evaluation of median difference in the ROM of shoulder movements after treatment
See this image and copyright information in PMC

References

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