Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review

Abstract

Objective: To perform a systematic review of randomized controlled trials (RCTs) on the efficacy of therapeutic exercises for workers suffering from rotator cuff (RC) tendinopathy. Methods: A literature search in four bibliographical databases (Pubmed, CINAHL, EMBASE, and PEDro) was conducted from inception up to February 2015. RCTs were included if participants were workers suffering from RC tendinopathy, the outcome measures included work-related outcomes, and at least one of the interventions under study included exercises. The methodological quality of the studies was evaluated with the Cochrane Risk of Bias Assessment tool. Results: The mean methodological score of the ten included studies was 54.4%±17.2%. Types of workers included were often not defined, and work-related outcome measures were heterogeneous and often not validated. Three RCTs of moderate methodological quality concluded that exercises were superior to a placebo or no intervention in terms of function and return-to-work outcomes. No significant difference was found between surgery and exercises based on the results of two studies of low to moderate methodological quality. One study of low methodological quality, comparing a workplace-based exercise program focusing on the participants' work demands to an exercise program delivered in a clinical setting, concluded that the work-based intervention was superior in terms of function and return-to-work outcomes. Conclusion: There is low to moderate-grade evidence that therapeutic exercises provided in a clinical setting are an effective modality to treat workers suffering from RC tendinopathy and to promote return-to-work. Further high quality studies comparing different rehabilitation programs including exercises in different settings with defined workers populations are needed to draw firm conclusions on the optimal program to treat workers.

Risk factors for rotator cuff tendinopathy: A systematic review and meta-analysis

“…Thirdly, inconsistency in the method of tendinopathy diagnoses may explain the large between-study heterogeneity. In the present systematic review, we included only symptomatic patients with rotator cuff tendinopathy diagnosed by clinical tests or conventional imaging, which have been adopted in previous studies in order to identify those with rotator cuff tendinopathy (3,19,20). The majority of the included studies used clinical diagnostic tests to determine the diagnosis of rotator cuff tendinopathy.…”

“…A study was included if: (i) participants presented with signs and symptoms suggestive of rotator cuff tendinopathy/ tendinosis/tendinitis, shoulder impingement syndrome, or subacromial bursitis diagnosed by clinical tests and/or conventional imaging (3,19,20); (ii) the study design was cross-sectional, case-control, prospective, and retrospective analyses; and (iii) the study report was published in English and full-text articles prior to June 2017. A study was excluded if: (i) participants were diagnosed with a rotator cuff full thickness tear or calcified ten-dinopathy, and other postsurgical conditions (3,19,20); (ii) the study population involved animal models or cadavers; and (iii) the study report was published as case studies, reviews (systematic and narrative), editorials, commentaries and opinion-based papers. Relevant studies were accessed for full-text review prior to inclusion in the systematic review.…”

“…One of the common causes of shoulder pain is rotator cuff tendinopathy, which is characterized by pain and weakness during external rotation and elevation (2). Rotator cuff tendinopathy is an umbrella term that includes different shoulder conditions affecting subacromial structures, such as rotator cuff tendinitis/ tendinosis, subacromial bursitis and shoulder impinge-ment syndrome (2)(3)(4). Rotator cuff tendinopathy is refractory to treatments (5), results in impaired activities of daily living and has a significant socio-economic burden due to loss of work and treatment costs (6).…”

“…These passive therapies work chiefly on symptom relief and may not alleviate the mechanical stress of tendon pathologies (12,13). Exercise therapy has been shown to be effective in reducing pain and improving function in rotator cuff tendinopathy (3). However, approximately 40% of patients with rotator cuff tendinopathy fail to respond to conservative treatment (14)(15)(16), and more than half of patients report recurrent and persistent pain over the long term (17).…”

“…repetitive overhead activities) have been shown to be the major mechanism of rotator cuff tendinopathy (18). Thus, the diagnosis of rotator cuff tendinopathy including rotator cuff tendinitis/tendinosis, subacromial bursitis and shoulder impingement syndrome, requires a battery of clinical tests and/or a combination of conventional imaging (3,19,20). A recent systematic review of risk factors related to rotator cuff tears has been reported by Sayampanathan & Andrew (21); however, their study included individuals with both symptomatic and asymptomatic rotator cuff tears diagnosed by conventional imaging or arthroscopic evaluation.…”