Summary of findings 5. Combination of manual therapy and exercise following joint distension compared with sham ultrasound following joint distension for adhesive capsulitis (frozen shoulder).

Combination of manual therapy and exercise following joint distension compared with sham ultrasound following joint distension for adhesive capsulitis (frozen shoulder)
Patient or population: patients with adhesive capsulitis (frozen shoulder) Settings: primary care and specialist practice in high‐income country Intervention: manual therapy plus exercise for six weeks following joint distension Comparison: sham ultrasound following joint distension
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Sham ultrasound following joint distension	Manual therapy plus exercise following joint distension
Participant‐reported pain relief ≥ 30%	See comment	See comment	Not estimable	‐	See comment	No studies reported this outcome
Overall pain (change from baseline) 0‐10 visual analogue scale (lower scores = lower pain) Follow‐up: 6 weeks	Mean overall pain (change from baseline) in the control group was 3.4	Mean overall pain (change from baseline) in the intervention group was 0 higher (0.69 lower‐0.69 higher)		148 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 0% (7% fewer to 7% more); relative percentage change 0% (13% fewer to 13% more) NNTB not applicable
Function (change from baseline) SPADI 0‐100 (lower scores = better function) Follow‐up: 6 weeks	Mean function (change from baseline) in the control group was 38.5	Mean function (change from baseline) in the intervention group was 0.5 lower (7.6 lower‐6.6 higher)		148 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 1% (8% fewer‐7% more); relative percentage change 1% (12% fewer to 11% more) NNTB not applicable
Active shoulder abduction (change from baseline) Degrees Follow‐up: 6 weeks	Mean active range of abduction (change from baseline) in the control group was 36	Mean active range of abduction (change from baseline) in the intervention group was 13.1 higher (4.2‐22 higher)		148 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 7% (2% fewer to 12% more); relative percentage change 19% (6% to 33% more). NNTB not calculated because there is no established minimal clinically important difference for this outcome.
Quality of life (change from baseline) SF‐36 Physical Component Score (0‐100) (lower scores = worse quality of life) Follow‐up: 6 weeks	Mean quality of life (change from baseline) in the control group was 8.3	Mean quality of life (change from baseline) in the intervention group was 0.5 lower (4.25 lower‐3.25 higher)		148 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 1% (4% fewer to 3% more); relative percentage change 2% (14% fewer to 11% more) NNTB not applicable
Global assessment of treatment success "Success, much improved, and/or completely recovered" (self‐rated) Follow‐up: 6 weeks	Study populationa		RR 1.33 (1.04‐1.69)	148 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 19% (3% to 34% more); relative percentage change 33% (4% to 69% more) NNTB = 6 (3 to 45)
	562 per 1000	747 per 1000 (584‐949)
Adverse events	Study population		RR 0.99 (0.14‐6.82)	149 (1 study)	⊕⊕⊕⊕ high	Absolute risk difference 0% (5% fewer to 5% more); relative percentage change 1% (86% fewer to 582% more) NNTH not applicable
	27 per 1000	27 per 1000 (4‐184)
*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; RR: risk ratio
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

^aRisk of treatment success in the sham ultrasound group of Buchbinder 2007 used as the assumed control group risk.