Scientific/Clinical ArticlesEffectiveness of rehabilitation for patients with Subacromial impingement syndrome: a systematic review
Section snippets
Data source
Bibliographic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials Register were searched from 1966 up to and including October 2003 with the search strategy defined in Table 1. Additionally, the references of all retrieved studies and all relevant conference proceedings were hand-searched. These search strategies yielded 634 eligible studies from the bibliographic databases, and hand-searching resulted in
Results
The 12 included studies were all randomized clinical trials or randomized controlled clinical trials investigating the efficacy of physical interventions for the treatment of patients with SAIS. Two studies48., 49. were combined for this systematic review, because they reported outcomes for the same group of subjects at two different follow-up periods. The mean quality score of included trials was 37.6, ranging from 33.5 to 41 points out of a total of a possible 69 points.
The inclusion criteria
Discussion
This systematic review examined the evidence for the efficacy of rehabilitation interventions for patients with SAIS. The limited evidence currently suggests that exercise, joint mobilization, and laser therapy are effective in decreasing pain and improving function in patients with SAIS. Ultrasound appears to be of no benefit, and acupuncture yielded equivocal findings from two trials. The number of trials examining each specific intervention was limited, and the quality of these trials was
Conclusions
Based on the available evidence for the physical rehabilitation of patients with SAIS, clinical practice guidelines were developed. The current literature most strongly supports the use of therapeutic exercise to strengthen the rotator cuff and scapular muscles and to stretch the soft tissues of the anterior and posterior shoulder. Therapeutic exercise appears to be more effective when combined with joint mobilization techniques focused on the shoulder and upper quarter. A course of therapeutic
Clinical practice recommendations
The following are grade B recommendations derived from level 1 or 2 studies. They are based on the ability of the indicated interventions to improve pain and functional loss or disability levels. These guidelines were devised to assist the clinician in evidence-based clinical decision making in patients with SAIS.
- 1.
Therapeutic exercise aimed at stretching the anterior and posterior shoulder girdle, and strengthening of the rotator cuff and scapular stabilizing muscles is recommended over no
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