EVALUATION OF THE EFFICACY OF AURICULAR VAGUS NERVE STIMULATION AND HOME EXERCISE PROGRAM IN PATIENTS WITH FROZEN SHOULDER: RANDOMIZED TRIAL

Abstract

Objective: This study aimed to evaluate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with a home exercise program on pain, range of motion (ROM), kinesiophobia, depression, and quality of life in patients with frozen shoulder. Methods: Eighty-one patients diagnosed with frozen shoulder were randomized into three groups: home exercise therapy, taVNS, and combined exercise + taVNS therapy. Pain intensity was assessed using the visual analog scale (VAS), depression with the Beck Depression Inventory, quality of life with the SF-36 questionnaire, shoulder ROM with goniometric measurements, shoulder function with the Shoulder Pain and Disability Index (SPADI), kinesiophobia with the Tampa Scale, and upper extremity functional limitation with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Significant improvements were observed in shoulder flexion and extension in the exercise group, while significant gains in abduction and adduction were detected in the combined exercise + taVNS group (p<0.05). SPADI and VAS scores showed statistically significant reductions in all groups following treatment (p<0.05). In addition, kinesiophobia and depression scores significantly decreased across all groups after the intervention period (p<0.05). Conclusion: Transcutaneous auricular vagus nerve stimulation appears to be a safe and effective adjunct to conventional exercise therapy in the management of frozen shoulder; however, its additional benefits beyond exercise alone may be limited.

Keywords

• Vagus nerve stimulation
• Exercise therapy
• Autonomic nervous system
• frozen shoulder

DONUK OMUZLU HASTALARDA AURİKÜLER VAGUS SİNİRİ STİMÜLASYONU VE EV EGZERSİZ PROGRAMININ ETKİNLİĞİNİN DEĞERLENDİRİLMESİ: RANDOMİZE KONTROLLÜ ÇALIŞMA

Öz

Amaç: Bu çalışma, transkütanöz auriküler vagus sinir stimülasyonu (taVNS) ile evde egzersiz programının, donuk omuzlu hastalarda ağrı, hareket açıklığı (ROM), kinesiofobi, depresyon ve yaşam kalitesi üzerindeki etkilerini değerlendirmeyi amaçlamıştır. Yöntem: Donuk omuz tanısı almış 81 hasta, üç gruba rastgele yerleştirilmiştir: evde egzersiz tedavisi, taVNS ve kombinasyonlu egzersiz + taVNS terapisi. Ağrı şiddeti, görsel analog skala (VAS) ile, depresyon Beck Depresyon Envanteri ile, yaşam kalitesi SF-36 anketi ile, omuz ROM'u goniyometrik ölçümlerle, omuz fonksiyonu Shoulder Pain and Disability Index (SPADI) ile, kinesiofobi Tampa Ölçeği ile ve üst ekstremite fonksiyonel kısıtlılık Disabilities of the Arm, Shoulder and Hand (DASH) anketi ile değerlendirilmiştir. Bulgular: Egzersiz grubunda omuz fleksiyon ve ekstansiyonunda anlamlı iyileşmeler gözlemlenirken, kombinasyonlu egzersiz + taVNS grubunda abduksiyon ve adduksiyonda anlamlı artışlar tespit edilmiştir (p<0,05). SPADI ve VAS skorları, tüm gruplarda tedavi sonrasında istatistiksel olarak anlamlı şekilde azalmıştır (p<0,05). Ayrıca, kinesiofobi ve depresyon skorları, tüm gruplarda müdahale süresi sonunda anlamlı şekilde azalmıştır (p<0,05). Sonuç: Transkütanöz auriküler vagus sinir stimülasyonu, donuk omuz tedavisinde konvansiyonel egzersiz tedavisinin güvenli ve etkili bir ek tedavi yöntemi gibi görünmektedir; ancak, egzersiz tedavisinin tek başına sağladığı faydalara ek sağladığı faydalar sınırlı olabilir.

Anahtar Kelimeler

• Vagus sinir stimülasyonu
• Egzersiz tedavisi
• Otonom sinir sistemi
• Donuk omuz

Kaynakça

1. Tamai K, Hamada J, Nagase Y, et al. Frozen shoulder: an overview of pathology and biology with hopes to novel drug therapies. Mod Rheumatol. 2024;34(3):439-443. doi:10.1093/mr/road087
2. Millar NL, Kraal T. The pathophysiology of frozen shoulder. In: Frozen Shoulder. Academic Press, 2024:13-23. doi:10.1016/B978-0-443-15995-4.00006-4
3. Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016; 6(1): 26-34. Published 2016 May 19. doi:10.11138/mltj/2016.6.1.026
4. Navarro-Ledesma S, Hamed-Hamed D, Pruimboom L. A new perspective of frozen shoulder pathology: the interplay between the brain and the immune system. Front Physiol. 2024;15:1248612. doi:10.3389/fphys.2024.1248612
5. Yıldız R, Özden AV, Nişancı OS, Yıldız Kızkın Z, Demirkıran BC. The effects of transcutaneous auricular vagus nerve stimulation on visual memory performance and fatigue. Turk J Phys Med Rehabil. 2023;69(3):327-333. doi:10.5606/tftrd.2023.11174
6. Hatik SH, Asrlan M, Demirbilek Ö, Özden AV. The effect of transcutaneous auricular vagus nerve stimulation on cycling ergometry and recovery in healthy young individuals. Brain Behav. 2023;13(12):e3332. doi:10.1002/brb3.3332
7. Şahbaz Y. Donuk omuzda konvansiyonel ultrason ile yüksek güçte ağri sinirinda ultrasonun etkinliğinin karşilaştirilmasi donuk omuzda iki farkli ultrason uygulama tekniği. Fizyoterapi Rehabilitasyon. 2019;30(2):104-111. doi:10.21653/tfrd.400116
8. Kowalsky MS. Adhesive capsulitis. In: The Resident's Guide to Shoulder and Elbow Surgery. 2022:119-132. doi:10.1007/978-3-031-12255-2_9

9. Austelle CW, O'Leary GH, Thompson S, et al. A comprehensive review of vagus nerve stimulation for depression. Neuromodulation. 2022;25(3):309-315. doi:10.1111/ner.13528
10. Georgiannos D, Markopoulos G, Devetzi E, Bisbinas I. Adhesive capsulitis of the shoulder: is there consensus regarding the treatment? A comprehensive review. Open Orthop J. 2017;11:65-76. doi:10.2174/1874325001711010065
11. De Carli A, Vadalà A, Perugia D, et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections? Int Orthop. 2012;36(1):101-106. doi:10.1007/s00264-011-1330-7
12. Fernandes MR. Patient-reported measures of quality of life and functional capacity in adhesive capsulitis. Rev Assoc Med Bras. 2017;63(4):347-354. doi:10.1590/1806-9282.63.04.347
13. Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2- to 27-year follow-up study. Clin Orthop Relat Res. 2012;470(4):1133-1143. doi:10.1007/s11999-011-2176-4
14. Mertens MG, Struyf F, Meert L, et al. Factors influencing treatment outcome of physical therapy in frozen shoulder patients: a systematic review. Eur J Physiother. 2022;24(3):174-190. doi:10.1080/21679169.2020.1827029
15. Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89(5):419-429. doi:10.2522/ptj.20080250
16. Rahbar M, Ranjbar Kiyakalayeh S, Mirzajani R, et al. Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: a randomized clinical trial. Clin Rehabil. 2022;36(5):669-682. doi:10.1177/02692155211070451
17. Wise SR, et al. Frozen shoulder: diagnosis and management. Curr Sports Med Rep. 2023;22(9):307-312. doi:10.1249/JSR.0000000000001097
18. Sigrist C, Torki B, Bolz LO, et al. Transcutaneous auricular vagus nerve stimulation in pediatric patients: a systematic review of clinical treatment protocols and stimulation parameters. Neuromodulation. 2023;26(3):507-517. doi:10.1016/j.neurom.2022.07.007
19. Do JG, Hwang JT, Yoon KJ, Lee YT. Correlation of ultrasound findings with clinical stages and impairment in adhesive capsulitis of the shoulder. Orthop J Sports Med. 2021;9(5):23259671211003675. doi:10.1177/23259671211003675
20. Tracey KJ. The inflammatory reflex. Nature. 2002;420(6917):853-859. doi:10.1038/nature01321
21. Rouhani A, Mardani-Kivi M, Bazavar M, et al. Calcitonin effects on shoulder adhesive capsulitis. Eur J Orthop Surg Traumatol. 2016;26(6):575-580. doi:10.1007/s00590-016-1816-5
22. Jain TK, Sharma NK. The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis: a systematic review. J Back Musculoskelet Rehabil. 2014;27(3):247-273. doi:10.3233/BMR-130443
23. Shabbir R, Arsh A, Darain H, Aziz S. Effectiveness of proprioceptive training and conventional physical therapy in treating adhesive capsulitis. Pak J Med Sci. 2021;37(4):1196-1200. doi:10.12669/pjms.37.4.3874
24. Cerritelli F, Frasch MG, Antonelli MC, et al. A review on the vagus nerve and autonomic nervous system during fetal development: searching for critical windows. Front Neurosci. 2021;15:721605. doi:10.3389/fnins.2021.721605
25. Kutlu N, Özden AV, Alptekin HK, Alptekin JÖ. The impact of auricular vagus nerve stimulation on pain and life quality in patients with fibromyalgia syndrome. Biomed Res Int. 2020;2020:8656218. doi:10.1155/2020/8656218
26. Sosa-Reina MD, Nunez-Nagy S, Gallego-Izquierdo T, et al. Effectiveness of therapeutic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized clinical trials. Biomed Res Int. 2017;2017:2356346. doi:10.1155/2017/2356346