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PLoS One. 2019 May 29;14(5):e0216961. doi: 10.1371/journal.pone.0216961. eCollection 2019.

The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis.

Author information

1
School of Physical Therapy, Faculty of Health Science, Western University, London ON Canada.
2
Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London ON Canada.
3
Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON Canada.

Abstract

OBJECTIVE:

To assess the effectiveness of surgical vs conservative interventions on pain and function in patients with subacromial impingement syndrome.

DESIGN:

Systematic review and meta-analysis of randomized controlled trials.

SETTING:

Clinical setting.

PARTICIPANTS:

Patients 18 years and older with subacromial impingement syndrome.

INTERVENTION/COMPARISON:

Surgical intervention plus postoperative physiotherapy / placebo surgery plus physiotherapy or physiotherapy only.

MAIN OUTCOME MEASURES:

Pain and function.

RESULTS:

11 RCTs (n = 919) were included. The pooled results displayed no statistically or clinically different between surgery plus physiotherapy vs physiotherapy alone on pain levels at 3-, 6-months, 5- and 10 years follow up (moderate quality, 3 RCTs, 300 patients, WMD -0.39, 95% CI: -1.02 to 0.23, p = 0.22; moderate quality, 3 RCTs, 310 patients, WMD -0.36, 95% CI: -1.02 to 0.29, p = 0.27; low quality, 1 RCT, 109 patients, WMD -0.30, 95% CI: -1.54 to 0.94, p = 0.64; low quality, 1 RCT, 90 patients, WMD -1.00, 95% CI: -0.24 to 2.24, p = 0.11) respectively. Similarly, the pooled results were not statistically or clinically different between groups for function at 3-, 6-month and 1-year follow ups (very low quality, 2 RCTs, 184 patients, SMD 0.11, 95% CI: -0.57 to 0.79, p = 0.75; moderate quality, 3 RCTs, 310 patients, SMD 0.15, 95% CI: -0.14 to 0.43, p = 0.31; very low quality, 2 RCTs, 197 patients, SMD 0.11, 95% CI: -0.46 to 0.69, p = 0.70) respectively.

CONCLUSION:

The effects of surgery plus physiotherapy compared to physiotherapy alone on improving pain and function are too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up.

PMID:
31141546
PMCID:
PMC6541263
DOI:
10.1371/journal.pone.0216961
[Indexed for MEDLINE]
Free PMC Article

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