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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| Vydané v: | Disability and rehabilitation Ročník 37; číslo 1; s. 1 - 8 |
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| Hlavní autori: | , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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England
Informa UK Ltd
01.01.2015
Informa Healthcare |
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| ISSN: | 0963-8288, 1464-5165, 1464-5165 |
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| Abstract | 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. |
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| AbstractList | To investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment.
Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date or language.
Controlled randomized (RCT) or quasi-randomized clinical trials comparing surgery and conservative treatment of shoulder impingement were included.
The methodological quality of each included trial was assessed according to the Cochrane Collaboration's domain-based evaluation framework.
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).
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 Rehabilitation 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 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. To investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment.OBJECTIVETo investigate the evidence on effectiveness of surgery for shoulder impingement compared with conservative treatment.Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date or language.DATA SOURCESCochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL and Science Citation Index databases were searched in March 2013 unrestricted by date or language.Controlled randomized (RCT) or quasi-randomized clinical trials comparing surgery and conservative treatment of shoulder impingement were included.STUDY SELECTIONControlled randomized (RCT) or quasi-randomized clinical trials comparing surgery and conservative treatment of shoulder impingement were included.The methodological quality of each included trial was assessed according to the Cochrane Collaboration's domain-based evaluation framework.DATA EXTRACTIONThe methodological quality of each included trial was assessed according to the Cochrane Collaboration's domain-based evaluation framework.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).DATA SYNTHESISOf 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).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 Rehabilitation 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 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.CONCLUSIONBased 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 Rehabilitation 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 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. 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 Rehabilitation 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 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. 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. |
| Author | Äärimaa, Ville Virolainen, Petri Saltychev, Mikhail Laimi, Katri |
| Author_xml | – sequence: 1 givenname: Mikhail surname: Saltychev fullname: Saltychev, Mikhail email: mikhail.saltychev@gmail.com, mikhail.saltychev@gmail.com organization: Department of Physical and Rehabilitation Medicine – sequence: 2 givenname: Ville surname: Äärimaa fullname: Äärimaa, Ville email: mikhail.saltychev@gmail.com, mikhail.saltychev@gmail.com organization: Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku – sequence: 3 givenname: Petri surname: Virolainen fullname: Virolainen, Petri email: mikhail.saltychev@gmail.com, mikhail.saltychev@gmail.com organization: Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku – sequence: 4 givenname: Katri surname: Laimi fullname: Laimi, Katri email: mikhail.saltychev@gmail.com, mikhail.saltychev@gmail.com organization: Department of Physical and Rehabilitation Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24694286$$D View this record in MEDLINE/PubMed |
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| Title | Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis |
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