Exercise as a conservative treatment modality for shoulder impingement syndrome : a systematic review

[摘要] Shoulder impingement syndrome (SIS) is a clinical presentation likely in people who participate inphysical activities, sports and occupations involving repeated overhead arm movements. It is oneof the most common causes of shoulder pain. Shoulder impingement syndrome can be treatedsurgically or conservatively, and it is generally asserted that to ensure effective rehabilitation,exercise interventions should be evidence-based with due regard to type, duration, frequency,intensity and supervision of exercise.In this dissertation, the first aim was to determine whether there is conclusive evidence for homebasedor supervised exercise as conservative treatment modality for SIS. Secondly, the studyaimed to determine consistencies in the type, duration, frequency and intensity of rehabilitationexercises that can serve as guidelines for rehabilitation of SIS. A systematic review and metaanalysisusing data from randomized, controlled intervention studies were conducted to meet theseaims. Only English publications meeting the inclusion criteria were included, resulting in six RCTs(n=475; intervention duration, 3 to 12 weeks) meeting the inclusion criteria. Outcomes of interestwere pain at rest, pain during movement, as well as shoulder ROM, patient satisfaction andfunction. Data were summarised and mean differences (MD), standard mean differences (SMD)and an overall effect size of 95% confidence intervals (CI) were extracted using Review Manager5.3.Pain at rest was reported by four studies and one study showed statistically significant improvementfor exercise (MD -1.90; 95% CI -3.36 to -0.44; p=0.01). All six studies reported pain duringmovement. Only two studies reported significant improvement in pain during movement favouringexercise (compared to no intervention) (SMD -0.81; 95% CI -1.18 to -0.44; p<0.0001) while theremaining studies reported no significant improvements between groups. Three studies assessedshoulder range of motion (ROM) and one ROM measurement (medial rotation) from one studyreported statistically significant improvement in the exercise group (MD 9.70; 95% CI 2.34 to 17.06;p=0.010). Two studies demonstrated no significant improvement in shoulder ROM among groups andwere inconclusive. Function was reported by all six studies and two studies demonstrated statisticallysignificant improvements for the exercise groups (SMD -0.66; 95% CI -1.02 to -0.29; p=0.0004).Two studies showed improvement in favour of the exercise group, but were not significant. One study favoured radial extracorporeal shockwave therapy (rESWT) but the results were also notsignificant and the results for this study were inconclusive. Patient satisfaction was reported by onestudy and showed statistically significant results in favour of the exercise group.Some patients in the exercise treatment groups improved significantly on key outcomemeasurements, but in other studies the improvements did not reach significant or clinically importantlevels. These results demonstrate a lack of moderate evidence for conservative exercise rehabilitationin the treatment of SIS with regards to frequency, intensity, duration and modality of treatment.Based on the limited evidence, guidelines were compiled for the treatment of SIS with exerciserehabilitation. However, more research is needed to obtain strong evidence for SIS rehabilitation andin order to update the proposed guidelines presented in this dissertation

[发布机构] North-West University