The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.

CE Hanratty, JG McVeigh, DP Kerr, JR Basford, MB Finch, A Pendleton, J Sim

    Research output: Chapter in Book/Report/Conference proceedingConference contribution

    Abstract

    Background: Exercise is a fundamental part of the management of subacromial impingement syndrome (SAIS), yet there has been relatively little examination of exercise interventions for this condition. Previous reviews in this area contain few randomized controlled trials (RCTs), have significant weaknesses, and none have conducted a rigorous meta-analysis of the data specifically related to exercise intervention. Questions remain regarding the overall effectiveness of exercise intervention in SAIS for example; which muscles should be targeted; and what is the optimal strengthening approach. The inconsistency of treatment and lack of guidelines may be reflected in the poor long-term outcome of conservative management of SAIS.1,2Objectives: To evaluate the effectiveness of exercise in the treatment of people with SAIS.Methods: A systematic review and meta-analysis was conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were RCTs investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarised 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 standardised mean difference with 95% confidence intervals (SMD (CI)).Results: Sixteen studies were included (total number of study participants=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. There was limited evidence that exercise reduced pain at long term follow-up. It was not possible to comment on the effect of exercise on long-term quality of life due to insufficient evidence. 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=0.020). There was no statistically significant effect of exercise on short-term function.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 (i.e. type, intensity, frequency and duration) were associated with best outcomes.
    LanguageEnglish
    Title of host publicationUnknown Host Publication
    Pages746-746
    Number of pages1
    Volume71
    Publication statusPublished - 2012
    EventEuropean League Against Rheumatism - Berlin, Germany
    Duration: 1 Jan 2012 → …

    Conference

    ConferenceEuropean League Against Rheumatism
    Period1/01/12 → …

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    Shoulder Impingement Syndrome
    Meta-Analysis
    Pain
    Randomized Controlled Trials
    Quality of Life
    Rotator Cuff
    Therapeutics
    Databases
    Guidelines
    Confidence Intervals
    Muscles

    Cite this

    Hanratty, CE., McVeigh, JG., Kerr, DP., Basford, JR., Finch, MB., Pendleton, A., & Sim, J. (2012). The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. In Unknown Host Publication (Vol. 71, pp. 746-746)
    Hanratty, CE ; McVeigh, JG ; Kerr, DP ; Basford, JR ; Finch, MB ; Pendleton, A ; Sim, J. / The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Unknown Host Publication. Vol. 71 2012. pp. 746-746
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    title = "The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.",
    abstract = "Background: Exercise is a fundamental part of the management of subacromial impingement syndrome (SAIS), yet there has been relatively little examination of exercise interventions for this condition. Previous reviews in this area contain few randomized controlled trials (RCTs), have significant weaknesses, and none have conducted a rigorous meta-analysis of the data specifically related to exercise intervention. Questions remain regarding the overall effectiveness of exercise intervention in SAIS for example; which muscles should be targeted; and what is the optimal strengthening approach. The inconsistency of treatment and lack of guidelines may be reflected in the poor long-term outcome of conservative management of SAIS.1,2Objectives: To evaluate the effectiveness of exercise in the treatment of people with SAIS.Methods: A systematic review and meta-analysis was conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were RCTs investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarised 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 standardised mean difference with 95{\%} confidence intervals (SMD (CI)).Results: Sixteen studies were included (total number of study participants=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. There was limited evidence that exercise reduced pain at long term follow-up. It was not possible to comment on the effect of exercise on long-term quality of life due to insufficient evidence. 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=0.020). There was no statistically significant effect of exercise on short-term function.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 (i.e. type, intensity, frequency and duration) were associated with best outcomes.",
    author = "CE Hanratty and JG McVeigh and DP Kerr and JR Basford and MB Finch and A Pendleton and J Sim",
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    Hanratty, CE, McVeigh, JG, Kerr, DP, Basford, JR, Finch, MB, Pendleton, A & Sim, J 2012, The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. in Unknown Host Publication. vol. 71, pp. 746-746, European League Against Rheumatism, 1/01/12.

    The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. / Hanratty, CE; McVeigh, JG; Kerr, DP; Basford, JR; Finch, MB; Pendleton, A; Sim, J.

    Unknown Host Publication. Vol. 71 2012. p. 746-746.

    Research output: Chapter in Book/Report/Conference proceedingConference contribution

    TY - GEN

    T1 - The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.

    AU - Hanratty, CE

    AU - McVeigh, JG

    AU - Kerr, DP

    AU - Basford, JR

    AU - Finch, MB

    AU - Pendleton, A

    AU - Sim, J

    PY - 2012

    Y1 - 2012

    N2 - Background: Exercise is a fundamental part of the management of subacromial impingement syndrome (SAIS), yet there has been relatively little examination of exercise interventions for this condition. Previous reviews in this area contain few randomized controlled trials (RCTs), have significant weaknesses, and none have conducted a rigorous meta-analysis of the data specifically related to exercise intervention. Questions remain regarding the overall effectiveness of exercise intervention in SAIS for example; which muscles should be targeted; and what is the optimal strengthening approach. The inconsistency of treatment and lack of guidelines may be reflected in the poor long-term outcome of conservative management of SAIS.1,2Objectives: To evaluate the effectiveness of exercise in the treatment of people with SAIS.Methods: A systematic review and meta-analysis was conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were RCTs investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarised 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 standardised mean difference with 95% confidence intervals (SMD (CI)).Results: Sixteen studies were included (total number of study participants=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. There was limited evidence that exercise reduced pain at long term follow-up. It was not possible to comment on the effect of exercise on long-term quality of life due to insufficient evidence. 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=0.020). There was no statistically significant effect of exercise on short-term function.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 (i.e. type, intensity, frequency and duration) were associated with best outcomes.

    AB - Background: Exercise is a fundamental part of the management of subacromial impingement syndrome (SAIS), yet there has been relatively little examination of exercise interventions for this condition. Previous reviews in this area contain few randomized controlled trials (RCTs), have significant weaknesses, and none have conducted a rigorous meta-analysis of the data specifically related to exercise intervention. Questions remain regarding the overall effectiveness of exercise intervention in SAIS for example; which muscles should be targeted; and what is the optimal strengthening approach. The inconsistency of treatment and lack of guidelines may be reflected in the poor long-term outcome of conservative management of SAIS.1,2Objectives: To evaluate the effectiveness of exercise in the treatment of people with SAIS.Methods: A systematic review and meta-analysis was conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were RCTs investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarised 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 standardised mean difference with 95% confidence intervals (SMD (CI)).Results: Sixteen studies were included (total number of study participants=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. There was limited evidence that exercise reduced pain at long term follow-up. It was not possible to comment on the effect of exercise on long-term quality of life due to insufficient evidence. 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=0.020). There was no statistically significant effect of exercise on short-term function.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 (i.e. type, intensity, frequency and duration) were associated with best outcomes.

    M3 - Conference contribution

    VL - 71

    SP - 746

    EP - 746

    BT - Unknown Host Publication

    ER -

    Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A et al. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. In Unknown Host Publication. Vol. 71. 2012. p. 746-746