Table 3

Description of studies included in the systematic review

Trial	Participants	Inclusion	Exclusion	Intervention
Ainsworth (2006)²⁴	10 patients	Clinical inclusion:	Neurological abnormality affecting the shoulder complex	Defined programme involving:
	Mean age 76 years	all or some of	Potentially operable RC tears	Active anterior deltoid strengthening, scapular exercises, patient education, adaptation, proprioception, home programme
	(range 70-83 years)	positive humeral thrust on elevation,	Patients involved in industrial claim or litigation	1 x 30 minute treatment each week for 4 weeks
	6 female	gross weakness and wasting of the supraspinatus and infraspinatus, infraspinatus lag, rupture of long head biceps		Then at 2–3 weekly intervals
	4 male	Ultrasound confirmation of massive rotator cuff tear (defined as leading edge of tear retracted past glenoid margin)		Duration and number of treatments not stated
	Onset:
	Not stated
	Duration of symptoms prior to treatment:
	Not stated
Bokor et al (1993)²⁵	53 patients from initial group of 80 patients.	Clinical inclusion:	Previous or subsequent surgery on the involved shoulder	NSAIDs
	Mean age at onset 62.2 years	Pain and / weakness		Strengthening and stretching
	(range 45–83 years)	Nonoperative course of treatment chosen by patient and clinician		Corticosteroid injections (16 shoulders)
	13 female	Arthrogram confirmation of rotator cuff tear		15 of these continued to have pain at final review
	40 male
	Onset:
	Trauma 40 patients
	Duration of symptoms prior to treatment:
	39 no history of symptoms prior to onset.
	< 3 months – 28 patients
	3–6 months – 9 patients
	> 6 months – 16 patients
Goldberg et al (2001)²⁶	46 patients	Clinical inclusion:	Workers compensation claim	Education
	Mean age 65 years	None stated	Previous surgery	Home strengthening and stretching programme
	(SD+11 years)	Elective nonoperative management.		Strengthening involving: rotator cuff specific exercises,
	24 female	Ultrasound, MRI or arthrogram confirmation of non-acute full thickness rotator cuff tear		Progressive supine press
	22 male			Stretching involving:
	Onset:			flexion, external and internal rotation and cross-body adduction
	Not stated
	Duration of symptoms prior to treatment:
	No acute tears (time not specified)
Hawkins and Dunlop (1995)²⁷	33 patients available for follow-up (from initial group of 50)	Clinical inclusion:		Supervised exercises over a 4-month period, and home programme, including:
	Mean age 59.6 years	Not stated		Internal and external rotation (with rubber tubing), short and long arc active flexion-extension exercises,
	6 female	Clinical assessment:		Scapular retraction, supraspinatus drill, diagonal proprioneuromuscular facilitation patterns with weights
	27 male	Muscle wasting		Strengthening exercises and proprioceptive patterning
	Onset:	‘Pop-eye’ deformity
	Traumatic 21	Active and passive movement
	Non-traumatic 12	Drop arm sign
	Duration of symptoms prior to treatment:	Strength tests
	1 month to 30 years	Double contrast arthrogram confirmation of rotator cuff tear
Heers et al (2005)²⁸	34 patients recruited	Clinical inclusion:	X-ray or MRI finding of subacromial spur	Home-based graduated exercise programme involving: 3 warm-up exercises, 4 stretching exercises, 5 strengthening exercises
	23 female	Neer Impingement Sign	Younger than 40 years	The home programme required 40 minutes per day for 12 weeks
	13 male	and / or	Older than 70 years
	Mean age 60.4 years (range 44–69)	Hawkins and Kennedy Test	Previous surgery
	Onset:	Clinical assessment	No analgesia permitted during 12-week programme
	Not stated	Range of movement:
	Duration of symptoms prior to treatment:	external rotation, flexion, abduction
	Group I: 30.4 (SD = 34.5) months	Ultrasound
	Group II: 28.8 (SD = 23.9) months
	Group III: 71.0 (SD = 48.3) months
Itoi and Tabata (1992)²⁹	114 patients (124 shoulders) recruited	Clinical inclusion:	Fracture or fracture dislocation of shoulder	Various combinations of: rest, NSAIDs, steroid injection (repeated to a maximum of 4 times)
	55 Female	None stated		After the symptoms had subsided: active and passive range of motion, and muscle strengthening exercises started
	59 Male	Clinical assessment:		Mean treatment period: 26 months (range 1–83 months)
	Onset:	Impingement test
	Not stated	Palpation tenderness
	Duration of symptoms prior to treatment:	Muscle atrophy
	Acute tears (<3 weeks) [15 shoulders]	Night pain
	3 weeks to 3 months [19 shoulders]	Motion pain
	3 months to 12 months [19 shoulders]	Arthrogram confirmation of rotator cuff tear
	> 12 months [9 shoulders]	6 patients with traumatic anterior dislocation of the shoulder were also included
Koubaa et al (2005)³⁰	Case series of 24 patients	Clinical inclusion:		Analgesics for mild pain, analgesics and NSAID (Piroxicam 20 mg/day for 14 days) for stronger pain
	15 female	None stated		Corticosteroid injection if medications did not reduce pain
	9 male	Clinical assessment		When pain was controlled rehabilitation programme commenced (3 times per week for 2 months)
	Mean age 59 years (range 44–83 years)	Pain at rest		This included:
	Onset:	Pain with activity		Pulsed ultrasound for 10 minutes and cervical massage prior to each treatment
	Chronic degenerative changes	Pain at night		Passive range of movement exercises.
	Duration of symptoms prior to treatment:	Range of movement		Humeral head depressor exercises (pectoralis major and latissimus dorsi).
	Mean 9.1 (SD = 12.3) months (range 3–32 months)	Impairment (VAS)		Abduction exercises
		Subjective benefit rated as: effective or very effective, little effect, not effective		Proprioceptive exercises
		Returned to work on other functional activities		Education (avoid shoulder flexion and sustained or repetitive overhead activities).
		All patients had refused surgical repair		Biofeedback exercises
		Ultrasound
Palmer (1998)³¹	Single case study	Clinical inclusion:	None stated	Active water-based exercises including stretching and strengthening and swimming for 3.5 months, divided into two phases
	1 female	None stated		Phase I: Water-based progressive resistance exercises, range of movement exercises, breast-stroke
	78 years	(Recommendation for surgery following medical examination)		Phase II: Overhead curl
	Onset:	MRI confirmation of FTT supraspinatus		Commenced at week 8
	Head-on motor vehicle collision			Patient seen on 10 occasions in clinic and continued programme at home in own therapeutic pool
	Duration of symptoms prior to treatment:
	6.5 months
Piccoli and Hasson (2004)³²	Single case study	Clinical inclusion:		Physical therapy 3 times per week for 7 weeks (19 visits)
	1 female	Full can test		Phase I
	Age 76 years	Drop arm test		Pulsed ultrasound, isometric shoulder exercises, active assisted movements, isokinetic exercises, scapular exercises, home programme and ice
	Onset:	Neer sign		Phase II
	Fall	Clinical assessment:		Isokinetic exercises, scapular exercises, active assisted exercises against gravity, active exercises, free weights, resistance tubing exercises
	Duration of symptoms prior to treatment:	Forward head posture		Phase III
	1 week	Scapular symmetry		Functional exercises, proprioceptive neuromuscular facilitation.
		Range of movement
		VAS (pain)
		Shoulder muscle strength
		MRI confirmation of FTT supraspinatus (5.0 cm)
Yamada et al (2000)³³	Case series of 13 patients choosing conservative treatment	Clinical inclusion:		Weeks 1–3 sling for comfort
	5 female	Not stated		CS injection (1–2/week; up to 15 injections in total)
	9 male	Arthrography		Hotpacks
	Mean age 70 years (range 55–81 years)			Passive range of movement for flexion and external rotation
	Onset:			Rotator cuff strengthening exercises
	Not stated			Injection, heat, exercise, passive movement
	Duration of symptoms prior to treatment:
	Mean 44 months (range 12 months to 11 years)