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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Exercise for rotator cuff tendinopathy: a systematic review

C Littlewood, J Ashton, K Chance-Larsen, S May, and B Sturrock.

Review published: 2012.

Link to full article: [Journal publisher]

CRD summary

This generally well-conducted review concluded that the available literature was supportive of the use of exercise for rotator cuff tendinopathy (a type of shoulder pain), but that the paucity of research and associated limitations warranted further study. The authors’ conclusions reflect the limitations of the evidence presented and seem appropriate.

Authors' objectives

To determine the effectiveness of exercise, incorporating a loading component, for rotator cuff tendinopathy.

Searching

MEDLINE, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and AMED were searched from inception to November 2010 for articles in any language. Search terms were reported. Reference lists of retrieved articles and systematic reviews were handsearched. Authors of pilot studies were contacted for additional data. Experts in the field were consulted.

Study selection

Randomised controlled trials (RCTs) of exercise that incorporated loading in participants with signs and symptoms suggestive of rotator cuff tendinopathy (definitions were provided in the review) were eligible for inclusion. Any clinical outcome was included. Trials in participants with painful/stiff shoulder associated with other diagnoses were excluded, as were trials of combined interventions for which the effectiveness of the exercise component could not be isolated.

The included trials studied supervised exercise versus no intervention, placebo or surgery; or home exercise versus no intervention, functional brace or multimodal physiotherapy. The mean age of participants ranged from 47.6 to 55.6 years; the proportion of men ranged from 23% to 100%.

Two reviewers independently performed study selection; disagreements were resolved by discussion.

Assessment of study quality

Two reviewers independently assessed trial quality using the Cochrane Back Review Group risk of bias tool, which appraised 12 quality items including randomisation, allocation concealment and selective reporting. Trials were only included if they were deemed at low risk of bias, which required them to fulfil six quality criteria and have no fatal flaw (definition provided in review). Disagreements between reviewers were resolved by discussion.

Data extraction

Data were extracted on clinical outcomes, including quality of life, pain, and Neer shoulder score. Trial authors were contacted for missing data.

Two reviewers independently extracted data; disagreements were resolved by discussion.

Methods of synthesis

A narrative synthesis was presented, grouping trials by interventions and comparators.

Results of the review

Four RCTs were included in the review (337 participants). All trials were deemed at low risk of bias.

One trial showed no difference between home exercise and multimodal physiotherapy or functional brace in the short term. One trial indicated a benefit of home exercise for shoulder pain and disability in the short term compared with no intervention. One trial found a benefit of supervised exercise for pain and function in the short term compared with no intervention; one trial showed a benefit of supervised exercise versus placebo (detuned laser) for pain and function in the short to long term. One trial showed no difference between supervised exercise and surgery in the short to long term.

Authors' conclusions

The available literature was supportive of the use of exercise, but the paucity of research and associated limitations warranted further study.

CRD commentary

Inclusion criteria for the review were clearly defined. Several relevant databases were searched for articles in any language. Publication bias was not assessed, although unpublished data were sought. Attempts were made to reduce error and bias throughout the review.

Quality assessment was undertaken using a valid tool; all included trials were deemed at a low risk of bias. Trials were synthesised narratively, which seemed appropriate given the type of data. The authors noted that caution was warranted when interpreting their results as some trials were not blinded, had no active comparator, and there were limitations with certain outcomes.

The review was generally well conducted. The authors’ conclusions reflect the limitations of the evidence presented and seem appropriate.

Implications of the review for practice and research

Practice: The authors stated that exercise therapy including a loading component was safe and not detrimental to outcomes, and had a useful role to play in managing rotator cuff tendinopathy.

Research: The authors stated that economic analyses and further trials of exercise with loading were needed. Trials should use credible comparators, and measure outcomes using validated tools. Where possible, some form of patient ‘naivety’ to treatment should be maintained. The differential effect of caregivers for one intervention over another should be minimised through the design of RCTs using cluster randomisation.

Funding

Not stated.

Bibliographic details

Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy 2012; 98(2): 101-109. [PubMed: 22507359]

Indexing Status

Subject indexing assigned by NLM

MeSH

Exercise Therapy /methods; Humans; Randomized Controlled Trials as Topic; Rotator Cuff; Tendinopathy /rehabilitation

AccessionNumber

12012021060

Database entry date

18/10/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 22507359