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The Effectiveness of Physiotherapy Exercises in Subacromial Impingement Syndrome: A Systematic Review and Meta-Analysis

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Objective

To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS).

Methods

A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)).

Results

Sixteen studies were included (n = 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD −0.46 (−0.76, 0.16); P = 0.003) and a small positive effect on long-term function (SMD −0.31 (−0.57, 0.04); P = 0.02).

Conclusions

Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes.

Section snippets

Materials and Methods

This study was conducted adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions (32, 33). The protocol for the review was registered with the Centre for Reviews and Dissemination (CRD32010000598).

Study Selection

Figure 2 displays the EMBASE database search strategy and Figure 3 outlines the results of the search strategy. The database and hand search yielded 2227 titles, which were reduced to 42 full-text articles that were screened for eligibility. After screening, 16 studies (1997-2010), involving 1162 participants, were eligible for qualitative appraisal. Two trials were analyzed together because they involved the same group of participants followed up at 2.5 years post intervention (40, 41).

Discussion

The aim of this review was to determine the overall effectiveness of exercise in the physiotherapy management of SAIS, and to guide clinicians regarding the most effective mode, frequency, duration, intensity, and progression of exercise interventions. We were able to come to a number of conclusions on the basis of the 16 studies we analyzed. All, however, are accompanied by caveats. First, the overall results of the qualitative synthesis suggest that exercise is effective at reducing pain and

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    Catherine Hanratty is a PhD student funded by the Department for Employment and Learning. No external funding was used.

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