Outcome, time frame | Measurement instruments and relative effects | Absolute effect estimates | Certainty in effect estimates (quality of evidence) | Plain text summary | |
Placebo surgery | Surgery | ||||
Pain, 6 months | Measured by VAS and NRS scaled to 0–10. Scale: 0–10, lower better. MID: 1.5 units. Based on data from 299 patients in 2 studies. | 3.9 | 4.0 | High. | Surgery has little or no effect on pain at 6 months. |
Difference: MD 0.07 higher (95% CI 0.51 lower to 0.64 higher). | |||||
Pain, 1 year | Measured by VAS and NRS scaled to 0–10. Scale: 0–10, lower better. MID: 1.5 units. Based on data from 284 patients in 2 studies. | 2.9 | 2.6 | High. | Surgery has little or no effect on pain at 1 year. |
Difference: MD 0.26 lower (95% CI 0.84 lower to 0.33 higher). | |||||
Function, 6 months | Measured by Constant Score. Scale: 0–100, higher better. MID: 8.3 points. Based on data from 286 patients in 2 studies. | 61 | 57 | High. | Surgery has little or no effect on function at 6 months. |
Difference: MD 3.72 lower (95% CI 8.72 lower to 1.28 higher). | |||||
Function, 1–2 years | Measured by Constant Score. Scale: 0–100, higher better. MID: 8.3 points. Based on data from 274 patients in 2 studies. | 69 | 72 | High. | Surgery has little or no effect on function at 1–2 years. |
Difference: MD 2.76 higher (95% CI 1.36 lower to 6.87 higher). | |||||
Global perceived effect, 6 months | Relative risk: 1.04 (95% CI 0.81 to 1.34). Based on data from 293 patients in 2 studies. | 447 per 1000 | 465 per 1000 | Moderate, due to serious imprecision*. | Surgery probably has little or no global perceived effect at 6 months. |
Difference: 18 more per 1000 (95% CI 85 fewer to 152 more). | |||||
Global perceived effect, 1 year | Relative risk: 1.1 (95% CI 0.94 to 1.3). Based on data from 290 patients in 2 studies. | 635 per 1000 | 699 per 1000 | Moderate, due to serious imprecision*. | Surgery probably has little or no global perceived effect at 1 year. |
Difference: 64 more per 1000 (95% CI 38 fewer to 190 more). | |||||
Quality of life, 6 months | Measured by EQ-5D. Scale: −0.59–1, higher better. MID: 0.07 units. Based on data from 292 patients in 2 studies. | 0.67 | 0.66 | High. | Surgery has little or no effect on quality of life at 6 months. |
Difference: MD 0.01 lower (95% CI 0.08 lower to 0.05 higher). | |||||
Quality of life, 1 year | Measured by EQ-5D. Scale: −0.59–1, higher better. MID: 0.07 units. Based on data from 285 patients in 2 studies.23 | 0.73 | 0.70 | High. | Surgery has little or no effect on quality of life at 1 year. |
Difference: MD 0.03 lower (95% CI 0.11 lower to 0.06 higher). | |||||
Serious harms† | Based on data from 25 240 patients in 2 observational studies. Follow-up 30 days. | Incidence: 5 or 6 (4 or 5–7)/1000 | Moderate, due to serious indirectness‡. | Surgery probably causes rare serious harms†. | |
Frozen shoulder, RCTs | Relative risk: 1.69 (95% CI 0.41 to 6.91). Based on data from 331 patients in 2 studies. |
18 per 1000 Difference, 12 more per 1000 (95% CI 11 fewer to 106 more). | 30 per 1000 | Low, due to very serious imprecision§. | Surgery may increase the incidence of frozen shoulder. |
*Imprecision: serious, wide CIs.
†Serious harms were death, bleeding (uncontrolled or requiring transfusion), cardiac arrest requiring cardiopulmonary resuscitation, myocardial infarction, cerebrovascular accident, acute renal failure, unplanned intubation, ventilator >48 hours, deep infection (surgical site or organ/space), sepsis, septic shock, wound dehiscence, pulmonary embolism, deep vein thrombosis and peripheral nerve injury.
‡Indirectness: serious. Differences between the intervention of interest and those studied; observational studies included other arthroscopic shoulder surgeries in addition to subacromial decompressions only.
§Imprecision: very serious. Low number of patients/events, wide CIs.
MID, minimally important difference; NRS, numeric rating scale; RCT, randomised controlled trial; VAS, visual analogue scale.