Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2024
2024
Historique:
received:
17
04
2023
accepted:
24
10
2023
medline:
29
4
2024
pubmed:
29
4
2024
entrez:
29
4
2024
Statut:
epublish
Résumé
Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.
Sections du résumé
BACKGROUND
BACKGROUND
Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain.
METHODS AND FINDINGS
RESULTS
Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7).
CONCLUSION(S)
CONCLUSIONS
Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.
Identifiants
pubmed: 38683828
doi: 10.1371/journal.pone.0294014
pii: PONE-D-23-11628
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0294014Informations de copyright
Copyright: © 2024 Silveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Br J Sports Med. 2023 Apr;57(8):457-463
pubmed: 36796859
J Pain. 2017 Jan;18(1):11-18
pubmed: 27720812
Ann Rheum Dis. 2004 Oct;63(10):1293-9
pubmed: 15361390
J Pain. 2018 Oct;19(10):1201-1210
pubmed: 29777953
Lasers Med Sci. 2012 Sep;27(5):951-8
pubmed: 22052627
Int J Sports Phys Ther. 2016 Apr;11(2):279-301
pubmed: 27104061
J Shoulder Elbow Surg. 2009 Nov-Dec;18(6):927-32
pubmed: 19535272
Arch Phys Med Rehabil. 2019 Nov;100(11):2136-2143
pubmed: 31247165
BMJ. 2010 Jun 28;340:c3037
pubmed: 20584793
Clin Rehabil. 2016 Jul;30(7):686-96
pubmed: 26160149
Syst Rev. 2018 May 2;7(1):68
pubmed: 29716639
Phys Ther. 2011 Feb;91(2):178-89
pubmed: 21212375
Qual Manag Health Care. 2019 Oct/Dec;28(4):209-221
pubmed: 31567844
Arch Phys Med Rehabil. 2014 Feb;95(2):345-52
pubmed: 24139986
Br J Sports Med. 2014 Oct;48(19):1431-6
pubmed: 24970843
Orthop Traumatol Surg Res. 2017 May;103(3):427-433
pubmed: 28215611
Man Ther. 2013 Oct;18(5):418-24
pubmed: 23523255
Physiother Theory Pract. 2023 Aug 3;39(8):1591-1605
pubmed: 35253581
Medicine (Baltimore). 2015 Mar;94(10):e510
pubmed: 25761173
Aust J Physiother. 2009;55(1):17-23
pubmed: 19226238
Aust J Physiother. 2003;49(3):183-8
pubmed: 12952518
Phys Ther. 2021 Mar 3;101(3):
pubmed: 33373455
BMC Med. 2021 Nov 23;19(1):304
pubmed: 34809639
Eur J Phys Rehabil Med. 2018 Jun;54(3):341-350
pubmed: 28655271
BMC Prim Care. 2023 Feb 16;24(1):49
pubmed: 36797670
Cochrane Database Syst Rev. 2016 Jun 10;(6):CD012224
pubmed: 27283590
Clin Rehabil. 2020 Oct;34(10):1245-1255
pubmed: 32508129
Photomed Laser Surg. 2018 Sep;36(9):506-513
pubmed: 30188253
Arthritis Rheum. 2008 May 15;59(5):615-22
pubmed: 18438933
Med Sci Sports Exerc. 2021 Jan;53(1):1-9
pubmed: 32555026
Int J Sports Phys Ther. 2017 Apr;12(2):297-304
pubmed: 28515984
Int J Rehabil Res. 2015 Jun;38(2):95-106
pubmed: 25715230
Am J Sports Med. 2015 Oct;43(10):2572-82
pubmed: 25622986
Iran Red Crescent Med J. 2015 Sep 28;17(9):e23732
pubmed: 26473076
Am J Phys Med Rehabil. 2016 Mar;95(3):169-82
pubmed: 26098920
J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9
pubmed: 23540577
Man Ther. 2015 Oct;20(5):646-56
pubmed: 25920340
Stem Cells Int. 2020 Jan 30;2020:5962354
pubmed: 32399045
JSES Int. 2021 Nov 20;6(1):167-174
pubmed: 35141692
Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2051-2059
pubmed: 27351548
Eur J Phys Rehabil Med. 2014 Jun;50(3):255-64
pubmed: 24429918
BMC Med Res Methodol. 2016 May 20;16:56
pubmed: 27206853
J Sport Rehabil. 2015 May;24(2):116-29
pubmed: 25054347
BMC Musculoskelet Disord. 2022 Dec 8;23(1):1073
pubmed: 36476476
J Back Musculoskelet Rehabil. 2019;32(3):519-527
pubmed: 30932877
Aust J Physiother. 2005;51(2):87-94
pubmed: 15924511
BMJ. 2010 Jun 08;340:c2756
pubmed: 20530557
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Physiotherapy. 2017 Jun;103(2):167-173
pubmed: 27884499
Campbell Syst Rev. 2020 Mar 11;16(1):e1080
pubmed: 37131978
J Occup Health. 2016 Sep 30;58(5):389-403
pubmed: 27488037
J Back Musculoskelet Rehabil. 2011;24(3):173-9
pubmed: 21849731
J Shoulder Elbow Surg. 2009 Jan-Feb;18(1):138-60
pubmed: 18835532
J Orthop Sports Phys Ther. 2014 Jan;44(1):30-9
pubmed: 24175606
Eur J Pain. 2017 Jul;21(6):1007-1019
pubmed: 28106306
Mil Med. 2019 May 1;184(5-6):e385-e393
pubmed: 30423137
BMJ. 2009 Sep 15;339:b3360
pubmed: 19755551
J Orthop Sports Phys Ther. 2016 Aug;46(8):617-28
pubmed: 27477473
Orthop J Sports Med. 2017 May 19;5(5):2325967117702366
pubmed: 28567426
Sports Health. 2024 Jan-Feb;16(1):97-108
pubmed: 36872599
Rheumatol Int. 2012 Oct;32(10):3007-16
pubmed: 21898066
Sports (Basel). 2020 Apr 13;8(4):
pubmed: 32294940
BMJ. 2012 Feb 20;344:e787
pubmed: 22349588
Clin Rehabil. 2019 May;33(5):894-903
pubmed: 30672303
Health Technol Assess. 2021 Aug;25(48):1-158
pubmed: 34382931
Br J Sports Med. 2016 Sep;50(18):1124-34
pubmed: 27288517
Br J Sports Med. 2017 Sep;51(18):1340-1347
pubmed: 28630217
PLoS Med. 2020 Apr 3;17(4):e1003082
pubmed: 32243458
J Clin Rheumatol. 2021 Jun 1;27(4):136-142
pubmed: 32975923
Physiotherapy. 2012 Jun;98(2):101-9
pubmed: 22507359
Sports Health. 2021 Mar;13(2):161-172
pubmed: 32986531
Am J Sports Med. 2017 Sep;45(11):2547-2554
pubmed: 28586628
J Exerc Rehabil. 2014 Feb 28;10(1):35-44
pubmed: 24678503
Evid Based Complement Alternat Med. 2015;2015:315219
pubmed: 26649058
BMC Med. 2011 Jan 24;9:8
pubmed: 21261971
BMJ Open. 2019 Feb 20;9(2):e028777
pubmed: 30787096
J Shoulder Elbow Surg. 2018 Feb;27(2):298-305
pubmed: 29162305
J Manipulative Physiol Ther. 2018 Mar - Apr;41(3):218-226
pubmed: 29459121
Phys Ther. 2011 Jan;91(1):37-47
pubmed: 21088117
Man Ther. 2011 Feb;16(1):33-9
pubmed: 20888284
Acta Orthop Traumatol Turc. 2009 Aug-Oct;43(4):331-5
pubmed: 19809230
Clin Rehabil. 2010 Feb;24(2):99-109
pubmed: 20103573
Rev Panam Salud Publica. 2022 Dec 30;46:e112
pubmed: 36601438
Acta Orthop Traumatol Turc. 2009;43(6):504-9
pubmed: 20134218
J Orthop Sports Phys Ther. 2020 Mar;50(3):131-141
pubmed: 31726927
PLoS One. 2014 Jul 03;9(7):e99682
pubmed: 24992266