Author Names
Innocenti, T., Ristori, D., Miele, S., & Testa, M.
Reviewer Name
Shelby Dobratz, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background: Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated. Objectives: To investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions. Methods: A systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken. Results: 6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups. Conclusions: Musculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment. Keywords: Diagnosis; Exercise; Musculoskeletal; Physical test; Rotator cuff; Shoulder.
NIH Risk of Bias Tool
Quality Assessment of Systematic Reviews and Meta-Analyses
- Is the review based on a focused question that is adequately formulated and described?
- Yes
- Were eligibility criteria for included and excluded studies predefined and specified?
- Yes
- Did the literature search strategy use a comprehensive, systematic approach?
- Yes
- Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
- Yes
- Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
- Were the included studies listed along with important characteristics and results of each study?
- Yes
- Was publication bias assessed?
- Cannot Determine, Not Reported, Not Applicable
- Was heterogeneity assessed? (This question applies only to meta-analyses.)
- Cannot Determine, Not Reported, Not Applicable
Key Finding #1
Despite weak diagnostic ability of clinical tests for patients with shoulder problems, musculoskeletal physiotherapy was effective.
Key Finding #2
Specific manual joint techniques decreased pain and increased mobility in this population compared to placebo.
Key Finding #3
Practicing physical therapists should be treating patients with shoulder impingement with a holistic care approach, over a disease-based approach.
Please provide your summary of the paper
This study examined the effectiveness of manual therapies in shoulder impingement and related disorders. Delgado-Gil et al. discovered significantly decreased pain and increased pain-free range of motion (ROM) when implementing mobilization with movement (MWM) compared to placebo (2015). However, an additional study comparing therapeutic exercise and therapeutic exercise plus manual therapy found no significant difference in scapular kinematics, functionality and pain compared to exercise alone (Camargo et al., 2015). It should be considered that disability/participation indexes were used in more than two of the studies reviewed, as well as varying choices of follow-up times. Overall, satisfactory effectiveness of musculoskeletal physiotherapy was concluded within this patient population.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Pain and functional disability are often not primarily related to structural factors in these patients with shoulder impingement and related disorders. To overcome these problems, clinicians should move from a disease-based approach to a more functional and prognostic approach. This way, many will adopt more functional diagnostic procedures and could implement more social and psychological features to gear interventions towards. In addition, manual therapies and mobilization techniques were shown to decrease pain and improve functional disability, but not greater than exercise alone, which can be carried through to the clinic.
