Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis

Abstract Objective: To investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment. Data sources: Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date...

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Veröffentlicht in:Disability and rehabilitation Jg. 37; H. 1; S. 1 - 8
Hauptverfasser: Saltychev, Mikhail, Äärimaa, Ville, Virolainen, Petri, Laimi, Katri
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Informa UK Ltd 01.01.2015
Informa Healthcare
Schlagworte:
Acromioplasty
effectiveness
Evidence-Based Medicine
exercise
Humans
pain
Pain Measurement
Randomized Controlled Trials as Topic
rehabilitation shoulder impingement
rotator cuff
Shoulder Impingement Syndrome - rehabilitation
Shoulder Impingement Syndrome - surgery
shoulder pain
surgery
treatment
effectiveness
treatment
pain
rotator cuff
exercise
rehabilitation shoulder impingement
shoulder pain
Acromioplasty
surgery
ISSN:0963-8288, 1464-5165, 1464-5165
Online-Zugang:Volltext
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Zusammenfassung:Abstract Objective: To investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment. Data sources: Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date or language. Study selection: Controlled randomized (RCT) or quasi-randomized clinical trials comparing surgery and conservative treatment of shoulder impingement were included. Data extraction: The methodological quality of each included trial was assessed according to the Cochrane Collaboration's domain-based evaluation framework. Data synthesis: Of seven included RCTs, risk of systematic bias was considered to be low for two, high for four, and unclear for one RCT. The random-effect meta-analysis was conducted on four RCTs involving 347 subjects (173 surgically treated cases and 174 controls). There was no significant difference in changes in pain intensity between surgically and conservatively treated subjects (Hedges's g = 0.01 in favor of conservative treatment, 95% CI −0.27 to 0.30). Conclusion: Based on the review of seven RCTs, the evidence on effectiveness of surgical or conservative treatment of shoulder impingement was found to be limited. There was, however, moderate evidence that surgical treatment is not more effective than active exercises on reducing pain intensity caused by shoulder impingement.Implications for RehabilitationBased on the review of seven RCTs, the evidence on effectiveness of surgical or conservative treatment of shoulder impingement was found to be limited.There was moderate evidence that surgical treatment is not more effective than active exercises on reducing pain intensity caused by shoulder impingement.Because of surgery's higher costs and susceptibility for complications compared with costs and risks of conservative treatment, conservative treatment can be recommended as a first choice of treatment of shoulder impingement in first or second grade.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Review-3
content type line 23
ObjectType-Undefined-4
ISSN:0963-8288
1464-5165
1464-5165
DOI:10.3109/09638288.2014.907364