SYSTEMATIC REVIEW article
Front. Med.
Sec. Family Medicine and Primary Care
Comparative Effectiveness of Acupuncture-Related Therapies for Frozen Shoulder: A Systematic Review and Network Meta-Analysis
Provisionally accepted
- 1Shanxi University of Chinese Medicine, Taiyuan, China
- 2Second Hospital of Shanxi Medical University, Taiyuan, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Methods: We searched Chinese and international databases, including PubMed, Cochrane Library, EMbase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biomedical Literature Database, for randomized controlled trials (RCTs) published from database inception to September 2025 on acupuncture and related therapies for Frozen Shoulder. Eligible studies were screened, and two independent reviewers assessed the quality and risk of bias using the ROB 2 tool from the Cochrane Handbook. Data were analyzed using Stata 18.0 software for network meta-analysis. The relative efficacy of each intervention was ranked using the surface under the cumulative ranking curve (SUCRA). Results: A total of 84 RCTs involving 7,125 patients and 17 interventions were included. For the overall effectiveness rate, small needle knife therapy showed the greatest improvement over both physical therapy (relative risk [RR] = 1.39, 95% confidence interval [CI] 1.21–1.60) and Western medicine (RR = 1.39, 95% CI 1.22–1.58). In terms of the apparent healing rate, joint mobilization combined with warm acupuncture-moxibustion achieved the most pronounced benefit compared with physical therapy (RR = 1.83, 95% CI 1.19–2.83) and Western medicine (RR = 2.19, 95% CI 1.36–3.54). For shoulder function, measured by the Constant–Murley Shoulder (CMS) score, floating needle therapy yielded the largest functional gain relative to physical therapy (standardized mean difference [SMD] = 3.12, 95% CI 1.91–4.33) and Western medicine (SMD = 4.87, 95% CI 3.47–6.26). Concerning pain intensity, assessed by the Visual Analogue Scale (VAS), Western medicine provided slightly greater pain reduction than acupuncture-based interventions, though the differences were not statistically significant. Adverse events were infrequent and generally mild, occurring less often in acupuncture-related therapies than in control groups. Across outcomes, the certainty of evidence ranged from low to moderate. Conclusion: Small needle knife therapy, joint mobilization plus warm acupuncture-moxibustion, and massage combined with acupuncture appear most effective for improving outcomes in frozen shoulder. Floating needle and moxibustion show advantages in restoring shoulder function. Acupuncture-based therapies are generally safe, but the overall evidence is of moderate-to-low certainty, warranting further high-quality, multicenter trials.
Keywords: Frozen shoulder, Acupuncture, Physiotherapy, effectiveness, Network meta-analysis
Received: 25 Jul 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Rongyao, Zhang and weng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Min Zhang, zhangminty126@126.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.