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Konstantakis X1, Pazaridis C1, Heneghan N1
1University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Physiotherapy, Birmingham, United Kingdom
Background: Subacromial pain syndrome (SAPS) constitutes the most common diagnostic subgroup of shoulder problems, for which therapeutic exercise (TE) is considered as an effective treatment intervention. Existing evidence suggests that its efficacy may be augmented when is combined with manual therapy (MT). However, the evidence regarding the effectiveness of this combined therapeutic approach is inconclusive. A limitation of the existing systematic reviews is the heterogeneity of the included treatment interventions for SAPS. Evidence report that the collective analysis of therapeutic interventions may lead to inaccurate estimation of treatment effect for particular treatments.Accordingly, it was considered appropriate to conduct a systematic review focusing on particular therapeutic methods for SAPS with the aim of establishing their effectiveness and thus informing clinical practice.
Purpose: To investigate whether TE combined with MT is superior to TE alone in improving patient reported outcomes of pain and shoulder function in patients with SAPS.
Methods: A systematic review was designed in accordance to published guidelines and reported in line with PRISMA. Key databases were searched until June 2018. Studies were included if they were RCT study designs, comparing TE with MT to TE alone and included measures of pain and disability. The Cochrane risk of bias tool was used to evaluate the quality of the included studies. Searching, data extraction and quality assessment was undertaken by 2 independent reviewers. Heterogeneity in key characteristics precluded meta-analysis.
Results: From 1.469 articles 15 full text articles were evaluated, resulting in 7 included RCTs.
Methodological deficits found in the majority of the studies, conduct of the studies; unclear randomisation methods; inadequate allocation concealment, raising doubts for the accuracy of the results. Thus 3 studies were classified as having high risk of bias while 3 had unclear risk of bias. Only one study (n=90) had low risk of bias, in which, the intervention group (TE with MT) reported a minor decrease of mean pain, measured by the visual numeric rating scale, at five weeks (RR of 1.46; 95% CI 1.012.10), indicating a minor additional effect of MT in a single TE programme.
Conclusion(s): Limited evidence suggests that MT may enhance the effectiveness of a single TE programme in improving pain and shoulder function in SAPS in the short term. Poor quality coupled with heterogeneity of both interventions precludes strong conclusions to be drawn.
Implications: More methodologically high quality studies are required to evaluate further this combined therapeutic approach and establish the optimal TE programme and MT regimen, thus allowing clinicians to take an evidence based practice approach when treating patients with acute, subacute and chronic SAPS.
Keywords: Exercise, Manual therapy, Subacromial pain syndrome
Funding acknowledgements: Unfunded
Purpose: To investigate whether TE combined with MT is superior to TE alone in improving patient reported outcomes of pain and shoulder function in patients with SAPS.
Methods: A systematic review was designed in accordance to published guidelines and reported in line with PRISMA. Key databases were searched until June 2018. Studies were included if they were RCT study designs, comparing TE with MT to TE alone and included measures of pain and disability. The Cochrane risk of bias tool was used to evaluate the quality of the included studies. Searching, data extraction and quality assessment was undertaken by 2 independent reviewers. Heterogeneity in key characteristics precluded meta-analysis.
Results: From 1.469 articles 15 full text articles were evaluated, resulting in 7 included RCTs.
Methodological deficits found in the majority of the studies, conduct of the studies; unclear randomisation methods; inadequate allocation concealment, raising doubts for the accuracy of the results. Thus 3 studies were classified as having high risk of bias while 3 had unclear risk of bias. Only one study (n=90) had low risk of bias, in which, the intervention group (TE with MT) reported a minor decrease of mean pain, measured by the visual numeric rating scale, at five weeks (RR of 1.46; 95% CI 1.012.10), indicating a minor additional effect of MT in a single TE programme.
Conclusion(s): Limited evidence suggests that MT may enhance the effectiveness of a single TE programme in improving pain and shoulder function in SAPS in the short term. Poor quality coupled with heterogeneity of both interventions precludes strong conclusions to be drawn.
Implications: More methodologically high quality studies are required to evaluate further this combined therapeutic approach and establish the optimal TE programme and MT regimen, thus allowing clinicians to take an evidence based practice approach when treating patients with acute, subacute and chronic SAPS.
Keywords: Exercise, Manual therapy, Subacromial pain syndrome
Funding acknowledgements: Unfunded
Topic: Musculoskeletal: upper limb
Ethics approval required: No
Institution: University of Birmimgham, School of Sport, Exercise and Rehabilitation Sciences
Ethics committee: University of Birmimgham, School of Sport, Exercise and Rehabilitation Sciences
Reason not required: it is a systematic review
All authors, affiliations and abstracts have been published as submitted.
