The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis

Abstract

Objective To assess the effectiveness of surgical vs conservative interventions on pain and function in patients with subacromial impingement syndrome. Design Systematic review and meta-analysis of randomized controlled trials. Setting Clinical setting. Participants Patients 18 years and older with subacromial impingement syndrome. Intervention/Comparison Surgical intervention plus postoperative physiotherapy / placebo surgery plus physiotherapy or physiotherapy only. Main outcome measures Pain and function. Results 11 RCTs (n = 919) were included. The pooled results displayed no statistically or clinically different between surgery plus physiotherapy vs physiotherapy alone on pain levels at 3-, 6-months, 5- and 10 years follow up (moderate quality, 3 RCTs, 300 patients, WMD -0.39, 95% CI: -1.02 to 0.23, p = 0.22; moderate quality, 3 RCTs, 310 patients, WMD -0.36, 95% CI: -1.02 to 0.29, p = 0.27; low quality, 1 RCT, 109 patients, WMD -0.30, 95% CI: -1.54 to 0.94, p = 0.64; low quality, 1 RCT, 90 patients, WMD -1.00, 95% CI: -0.24 to 2.24, p = 0.11) respectively. Similarly, the pooled results were not statistically or clinically different between groups for function at 3-, 6-month and 1-year follow ups (very low quality, 2 RCTs, 184 patients, SMD 0.11, 95% CI: -0.57 to 0.79, p = 0.75; moderate quality, 3 RCTs, 310 patients, SMD 0.15, 95% CI: -0.14 to 0.43, p = 0.31; very low quality, 2 RCTs, 197 patients, SMD 0.11, 95% CI: -0.46 to 0.69, p = 0.70) respectively. Conclusion The effects of surgery plus physiotherapy compared to physiotherapy alone on improving pain and function are too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up.

Prevalence of musculoskeletal disorders among Canadian firefighters: A systematic review and meta-analysis

“…Identifying prevalence estimates and distribution of MSDs is necessary to assist the development of datadriven rehabilitation programs. [25][26] In this review, near ly 1 out of 4 Canadian firefighters reported having suf fered from shoulder, back or knee pain in the past three months. Therefore, physical therapists and other health care providers, and personnel with a keen understand ing of the occupational knowledge and specifi c biome chanical requirements of the MSK system, are indicated in the design and implementation of rehabilitation pro grams that take into account firefighters' demands and occupational requirements.…”

Symptom response to mobilization and outcomes in patients with subacromial pain syndrome: A cohort study

“…Long‐term outcomes (5 years) for those that have surgery to correct pathoanatomic variants related to SAPS are no better than diagnostic arthroscopy (Sham) or “exercise therapy” (Paavola et al., 2021). Additionally, the differences between surgical outcomes in this subgroup of patients at 3‐months up to and exceeding a 10‐year follow‐up compared to “physiotherapy” are not clinically meaningful (Nazari et al., 2019).…”

Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

“…Treatment of RC can be conservative or surgical [24][25][26][27][28]. Surgery is performed after trauma or a conservative treatment failure to improve shoulder function and relieve pain [29][30][31]. Among surgical techniques, arthroscopy is the most commonly performed because of minor trauma to the deltoid due to smaller incisions, less postoperative pain, and the possibility of addressing concomitant disorders [32][33][34][35][36][37][38][39][40][41][42][43][44][45].…”