Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

Abstract

Objective: The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder. Methods: The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain. Results: Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low-to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions. Conclusion: The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions. (J Manipulative Physiol Ther 2017;40:293-319)

Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review

“…Systematic reviews/meta-analyses (both abbreviated as SR), RCTs, and cohort studies were evaluated using modified versions of the Scottish Intercollegiate Guideline Network (SIGN) checklist [31][32][33] (https://www.sign.ac.uk/ checklists-and-notes). Using the SIGN checklists, each article is scored as "high quality, low risk of bias," "acceptable quality, moderate risk of bias," "low quality, high risk of bias," or "unacceptable" quality.…”

“…The items in each checklist and explanation of the scoring system used to determine quality rating can be found in the supplemental file rating evidence and search strategy. [31][32][33][34] At least 2 investigators evaluated each article. If there was a disagreement between the 2 reviewers, a third investigator was asked to review (C.A.W.).…”

“…We used criteria for determining strength of evidence based on an adapted version of the US Preventive Services Task Force criteria as in the UK report 34,35 and used by others. 31 Strength was rated as "high," "moderate," or "inconclusive" (Supplementary Table 5). In addition, a description of the outcomes was included, as such that if all articles showed improvement they are classified as "favorable"; if all articles failed to show improvement they are classified as "non-favorable"; and if all articles showed a mix of improvement, a lack of improvement, or no difference they are classified as "unclear.…”

“…51 Exercise. There were 5 SRs that examined land- 30,39,41,51 or water-based 42 exercise; 1 was of high quality, 39 3 were acceptable quality, 31,42,43 and 1 was low quality. 51 There were 7 RCTs and 1 cohort study pertaining to pain and disability.…”

Lagerungstherapie bei bindegewebigen Gelenkkontrakturen am Beispiel der Frozen Shoulder

“…Eine andere Literaturanalyse konnte aufgrund der heterogenen Studien keine abschließenden Schlussfolgerungen ziehen, auch wenn Hinweise auf positive Wirkungen der Gelenkmobilisation -besonders nach posterior für die Außenrotation -im Vergleich zu Behandlungen ohne Gelenkmobilisation vorlagen [5]. Mit niedriger bis mäßiger Evidenz wies eine andere Literaturstudie ebenfalls auf die Wirksamkeit der Mobilisation bei Frozen Shoulder hin [16].…”