Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration (original) (raw)
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BMJ, 2012
Objective To evaluate if a specific exercise strategy, targeting the rotator cuff and scapula stabilisers, improves shoulder function and pain more than unspecific exercises in patients with subacromial impingement syndrome, thereby decreasing the need for arthroscopic subacromial decompression. Design Randomised, participant and single assessor blinded, controlled study. Setting Department of orthopaedics in a Swedish university hospital. Participants 102 patients with long standing (over six months) persistent subacromial impingement syndrome in whom earlier conservative treatment had failed, recruited through orthopaedic specialists. Interventions The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers in combination with manual mobilisation. The control exercise programme consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received five to six individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks. Main outcome measures The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery. Results Most (97, 95%) participants completed the 12 week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points (95% confidence interval 19 to 28.0) v 9 points (5 to 13); mean difference between group: 15 points (8.5 to 20.6)). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment: 69% (35/51) v 24% (11/46); odds ratio 7.6, 3.1 to 18.9; P<0.001. A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery: 20% (10/51) v 63% (29/46); odds ratio 7.7, 3.1 to 19.4; P<0.001). Conclusion A specific exercise strategy, focusing on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilisers, is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome. By extension, this exercise strategy reduces the need for arthroscopic subacromial decompression within the three month timeframe used in the study.
To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS). Methods: A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)). Results: Sixteen studies were included (n ϭ 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD Ϫ0.46 (Ϫ0.76, 0.16); P ϭ 0.003) and a small positive effect on long-term function (SMD Ϫ0.31 (Ϫ0.57, 0.04); P ϭ 0.02). Conclusions: Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes. A pproximately 1% of adults seek medical attention for shoulder pain each year (1). As such, it is the third most common musculoskeletal reason for general practitioner consultations and estimates of its prevalence in the UK range from 7% to 26% (2-4). Because the shoulder stabilizes the upper limb in its activities, shoulder pain, and particularly subacromial impingement syndrome (SAIS) pain, produces significant impairments in function and quality of life (QoL) (5,6).
BMC Musculoskeletal Disorders, 2017
Background: Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. Methods: Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. Results: Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD −0.19 (95% CI −0.61, 0.22) and SMD 0.30 (95% CI −0.16, 0.76) for function. Conclusions: There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area.
Turkish journal of physical medicine and rehabilitation, 2020
Objectives This study aims to investigate the effects of joint mobilization with supervised exercise in patients with subacromial impingement syndrome (SAIS). Patients and methods This prospective, randomized-controlled study included a total of 40 patients (18 males, 22 females; mean age 43.52 years; range, 27 to 67 years) with SAIS of more than six weeks between June 2014 and June 2015. The patients were randomly allocated into two groups: Group 1 (n=20) received joint mobilization and neuromuscular electrical stimulation and Group 2 (n=20) received a supervised exercise program and neuromuscular electrical stimulation. The outcome measures included the range of motion, pain intensity, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form-patient self-report section, Short Form-36, and Global Rating of Change Questionnaire. Pain was evaluated using the visual analog scale (VAS). Results In bo...
Physical therapy, 2016
Shoulder pain resulting from subacromial impingement syndrome (SAIS) is a common problem with a relatively poor outcome. There is little research exploring physical therapists' perspectives on the management of the syndrome. To investigate physical therapists' perceptions and experiences regarding the use of exercise in the treatment of patients with SAIS. Qualitative focus group study. Three 60-90 minute focus group sessions containing 6-8 experienced musculoskeletal physical therapists (total n=20) were conducted. Thematic content analysis was used to analyse transcripts and develop core themes and categories. Exercise was seen as key in the treatment of SAIS. The overarching theme was the need to "gain buy-in to exercise" at an early stage. The main subtheme was patient education i.e. the use of "patient education" appeared to be how therapists achieved buy-in to exercise. Therapists identified the need to use education about SAIS etiology to foster bu...
International journal of sports physical therapy, 2016
While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of exercise training interventions has not been defined. The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises. Level I randomized crossover trial. This was a prospective study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome (SAIS). They were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation. The results showed significa...
International journal of sports physical therapy, 2015
Researchers have demonstrated moderate evidence for the use of exercise in the treatment of subacromial impingement syndrome (SAIS). Recent evidence also supports eccentric exercise for patients with lower extremity and wrist tendinopathies. However, only a few investigators have examined the effects of eccentric exercise on patients with rotator cuff tendinopathy. To compare the effectiveness of an eccentric progressive resistance exercise (PRE) intervention to a concentric PRE intervention in adults with SAIS. Randomized Clinical Trial. Thirty-four participants with SAIS were randomized into concentric (n = 16, mean age: 48.6 ± 14.6 years) and eccentric (n = 18, mean age: 50.1 ± 16.9 years) exercise groups. Supervised rotator cuff and scapular PRE's were performed twice a week for eight weeks. A daily home program of shoulder stretching and active range of motion (AROM) exercises was performed by both groups. The outcome measures of the Disabilities of the Arm, Shoulder, and H...
Background: There are many treatments given for subacromial impingement syndrome which includes Anti-inflammatory Drugs, Massage, However, studies involving wax bath therapy and concentric and eccentric exercise for management of subacromial impingement syndrome are limited to this date. Objective: To find out and compare the effects of concentric and eccentric exercises in subjects with subacromial impingement syndrome. Study design: Quasi experimental study design, Comparative type. Procedure: 5subjects were treated with wax bath therapy with eccentric exercise and other 5 were treated with wax bath therapy with concentric exercise in age group 25 - 50 years of both male and female. Outcome measures : Neumeric Pain Rating Scale (NPRS) and Shoulder Pain And Disability Index(SPADI) . Results: The results of this study were analyzed in SPSS software gives p>0.05 which shows that there is a significant difference in the pre and post test values of Shoulder Pain and Disability index of Group A treated with wax bath and concentric exercises whereas Group B subjects treated with wax bath therapy and eccentric exercises show a significant improvement in pain, Range of motion and Shoulder Pain and Disability index for. Conclusion: There is no significant difference between concentric and eccentric exercises training among patients with Subacromial impingement syndrome.
Prior systematic reviews of rehabilitation for nondescript shoulder pain have not yielded clinically applicable results for those patients with subacromial impingement syndrome (SAIS). The purpose of this study was to examine the evidence for rehabilitation interventions for SAIS. The authors used data source as the method. The computerized bibliographic databases of Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Database of Systematic Reviews were searched from clinical trials. Randomized clinical trials that investigated physical interventions used in the rehabilitation of patients with SAIS with clinically relevant outcome measures of pain and quality of life were selected. The search resulted in 635 potential studies, 12 meeting inclusion criteria. Two independent reviewers graded all 12 trials with a quality checklist averaged for a final quality score. The mean quality score for 12 trials was 37.6 out of a possible 69 points. Various treatments were evaluated: exercise in six trials, joint mobilizations in two trials, laser in three trials, ultrasound in two trials, and acupuncture in two trials. The limited evidence currently available suggests that exercise and joint mobilizations are efficacious for patients with SAIS. Laser therapy appears to be of benefit only when used in isolation, not in combination with therapeutic exercise. Ultrasound is of no benefit, and acupuncture trials present equivocal evidence. The low to mediocre methodologic quality, small sample sizes, and general lack of long-term follow-up limit these findings for the development of useful clinical practice guidelines. Further trials are needed to investigate these rehabilitation interventions, the superiority of one intervention over another, and the long-term outcomes of rehabilitation. Moreover, it is imperative that clinical guidelines are developed to indicate those patients who are likely to respond to rehabilitation.