Effects of Pain Neuroscience Education and Graded Motor Imagery Combined With Conventional Physiotherapy on Pain, Kinesiophobia, and Functional Disability in Diabetic Adhesive Capsulitis
The purpose of this study is to determine the effects of Pain Neuroscience Education (PNE) and Graded Motor Imagery (GMI) combined with conventional physiotherapy on pain, kinesiophobia, central sensitization, functional disability, range of motion, and quality of life in patients with Type II diabetic adhesive capsulitis. Adhesive capsulitis is a common musculoskeletal condition characterized by pain and progressive restriction of shoulder movement, particularly among individuals with diabetes mellitus. Conventional physiotherapy is widely used to restore shoulder mobility and function; however, it may not adequately address central sensitization and fear of movement. Pain Neuroscience Education aims to improve patients' understanding of pain mechanisms and reduce maladaptive beliefs, while Graded Motor Imagery targets cortical reorganization and movement-related fear. The combination of these interventions with conventional physiotherapy may improve clinical outcomes and enhance quality of life.
This study is a randomized controlled trial with a parallel-group design to evaluate the effectiveness of Pain Neuroscience Education (PNE) and Graded Motor Imagery (GMI) combined with conventional physiotherapy in patients with Type II diabetic adhesive capsulitis. A total of 50 participants meeting the inclusion and exclusion criteria will be recruited using a non-probability convenience sampling technique and randomly allocated into two groups. * Experimental Group: Participants will receive Pain Neuroscience Education, Graded Motor Imagery, and conventional physiotherapy. * Control Group: Participants will receive conventional physiotherapy alone. Both groups will undergo treatment for 6 weeks, with three treatment sessions per week. The experimental intervention will include weekly Pain Neuroscience Education sessions, progressive Graded Motor Imagery (laterality recognition, motor imagery, and mirror therapy), along with conventional physiotherapy consisting of joint mobilization, stretching, strengthening, range-of-motion exercises, and functional training. Outcome assessments will be performed at baseline (Week 0), mid-treatment (Week 3), and post-treatment (Week 6). The primary outcome measures will include pain intensity (Numeric Pain Rating Scale), shoulder range of motion (Universal Goniometer), functional disability (Shoulder Pain and Disability Index), kinesiophobia (Tampa Scale of Kinesiophobia), and central sensitization (Central Sensitization Inventory). Quality of life will be assessed using the Short Form-36 (SF-36) questionnaire. The findings of this study will determine whether adding Pain Neuroscience Education and Graded Motor Imagery to conventional physiotherapy provides superior improvements in pain, psychological outcomes, functional ability, and quality of life compared with conventional physiotherapy alone.
Inclusion Criteria: * Diagnosed cases of adhesive capsulitis (Stage I or II) * Diagnosed with Type II Diabetes Mellitus * Age between 40-65 years * Shoulder pain lasting more than 3 months * Limited shoulder range of motion.
Exclusion Criteria: * Previous shoulder surgery * History of fracture or dislocation of shoulder * Cervical radiculopathy * Neurological disorders * Severe diabetic complications * Cognitive impairments.
[{"measure":"Pain intensity measured by Numeric Pain Rating Scale (NPRS)","timeFrame":"Baseline (Week 0), Week 3, and Week 6"},{"measure":"Shoulder Pain and Disability Measured by the Shoulder Pain and Disability Index (SPADI).","timeFrame":"Baseline (Week 0), Week 3, and Week 6"},{"measure":"Shoulder Range of Motion Measured Using a Universal Goniometer","timeFrame":"Baseline (Week 0), Week 3, and Week 6"},{"measure":"Kinesiophobia Measured by the Tampa Scale of Kinesiophobia (TSK-17).","timeFrame":"Baseline (Week 0), Week 3, and Week 6"},{"measure":"Central Sensitization Measured by the Central Sensitization Inventory (CSI).","timeFrame":"Baseline (Week 0), Week 3, and Week 6"}]