Pain Neuroscience Education and Graded Motor Imagery Combined With Conventional Physiotherapy on 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.

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.