ReviewConservative or surgical treatment for subacromial impingement syndrome? A systematic review
Section snippets
Literature search
A search of the literature in PubMed (from 1948 onward), EMBASE (from 1947 onward), PEDro (from 1929 onward), and the Cochrane Central Register of Controlled Trials was conducted to identify relevant publications until October 2007, without language restrictions. The literature search strategy for PubMed is presented in Table I. Reference lists of retrieved articles and articles on surgical interventions for SIS were screened for additional publications. Names of first authors of selected
Study selection
The PubMed search resulted in 162 citations (Table I). One more citation was found in the Cochrane Register. No other studies were identified through the EMBASE or PEDro databases by hand search or citation tracking. The title or abstract, or both, was used to exclude 155 articles (Figure 1), and 8 were retrieved for a more detailed evaluation. Next, 2 RCTs were excluded for reasons of poster presentation and commentary. Six articles describing 4 RCTs met our inclusion criteria.7, 8, 19, 20, 31
Discussion
Failed conservative treatment of SIS is often followed by surgery. This systematic review was designed to determine if the results of surgery for SIS are better than those of conservative treatment in terms of improvement of shoulder function and reduction of pain.
Recommendations
To answer the question of whether surgery for SIS is indeed more effective than conservative treatment, high-quality trials are needed. These trials should use outcome measures that quantify improvement of shoulder function and reduction of pain that are valid, reliable, and responsive in these study populations. Correct tests, such as the impingement test, should be used to diagnose patients with SIS, and strict inclusion and exclusion criteria should be observed to create homogenous study
Acknowledgments
This study was supported by a grant from University Medical Center Groningen, The Netherlands. We thank Truus van Ittersum for her help in developing search strategies for the electronic databases used. We are also grateful to Daniëlle van der Windt for her comments. This study is supported by a grant from University Medical Center Groningen, The Netherlands.
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This study was supported by a grant from University Medical Center Groningen, The Netherlands.