Active versus Passive physiotherapy for chronic shoulder pain: a systematic review and meta-analysis

Abstract

Objective To explore the effects of active physiotherapy (AP) and passive physiotherapy (PP) on pain intensity and function in patients with chronic shoulder pain.Design Systematic review and meta-analysis.Methods Two independent researchers searched PubMed, Cochrane library, Embase, Web of science, CINAHL and PEDro from the beginning to September 7, 2022. All included studies were evaluated for risk of bias by the Cochrane risk-of-bias tool and the certainty of results was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.Eligibility criteria Randomized controlled trials (RCTs) involving patients with chronic shoulder pain were included. The treatment must be AP versus PP.Results Altogether 21 studies, including 1011 patients, were included. The primary result: Compared with passive manipulation, AP was superior in the pressure pain threshold (PPT) of shoulder (SMD-0.09, 95%CI: -0.42 to 0.24, P = 0.59), pain intensity (SMD-0.37, 95%CI: -0.71 to -0.03, P = 0.03) and function (SMD-0.22, 95%CI: -0.43 to -0.01, P = 0.04). AP had an advantage over physical factor therapy in terms of pain intensity (SMD-1.32, 95%CI: -2.34 to -0.29, P = 0.01) and function (SMD-0.64, 95%CI: -1.15 to -0.14, P = 0.01). The secondary result: AP was superior to PP at short-term and medium-term follow-up, with no difference at long-term follow-up.Conclusions Evidence with moderate to very low certainty suggests AP was superior to PP in pain and functional improvement in patients with chronic shoulder pain at short-term and medium-term follow-up, but this advantage was not observed in the long-term follow-up.