The mean change in pain with glucocorticoid injection was 58 points on a 100‐point scale, and 32 points with manual therapy and exercise (mean difference (MD) 26 points, 95% confidence interval (CI) 15 points to 37 points one RCT, 107 participants), for an absolute difference of 26% (15% to 37%). Evidence of moderate quality shows that a combination of manual therapy and exercise for six weeks probably results in less improvement at seven weeks but a similar number of adverse events compared with glucocorticoid injection. The overall impression gained from these trials is that the few outcome differences between interventions that were clinically important were detected only up to seven weeks. Seven trials compared a combination of manual therapy and exercise versus other interventions but were clinically heterogeneous, so opportunities for meta‐analysis were limited. No trial compared a combination of manual therapy and exercise versus placebo or no intervention. We included 32 trials (1836 participants). Two review authors independently selected trials for inclusion, extracted the data, performed a risk of bias assessment and assessed the quality of the body of evidence for the main outcomes using the GRADE approach. Main outcomes of interest were participant‐reported pain relief of 30% or greater, overall pain (mean or mean change), function, global assessment of treatment success, active shoulder abduction, quality of life and the number of participants experiencing adverse events. Trials investigating the primary or adjunct effect of a combination of manual therapy and exercise were the main comparisons of interest. Interventions included mobilisation, manipulation and supervised or home exercise, delivered alone or in combination. We included randomised controlled trials (RCTs) and quasi‐randomised trials, including adults with adhesive capsulitis, and comparing any manual therapy or exercise intervention versus placebo, no intervention, a different type of manual therapy or exercise or any other intervention. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL Plus, and the WHO ICTRP clinical trials registries up to May 2013, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials, to identify potentially relevant trials. To synthesise available evidence regarding the benefits and harms of manual therapy and exercise, alone or in combination, for the treatment of patients with adhesive capsulitis. This review is one of a series of reviews that form an update of the Cochrane review, 'Physiotherapy interventions for shoulder pain.' Objectives Adhesive capsulitis (also termed frozen shoulder) is commonly treated by manual therapy and exercise, usually delivered together as components of a physical therapy intervention.
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