PHYSICAL THERAPY & REHAB
Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(19):5 BMC Musculoskelet Disord. 2017 Apr 17;18(1):158Six randomized controlled trials (231 patients) were included in this analysis comparing short-term pain and functional outcome between a specific exercise program and general exercise program in the management of patients with subacromial impingement syndrome. Compiling data at 4-8 week follow-up, results demonstrated no significant differences between the two strategies in pain during activity, or in functional outcome. Further high-quality trials are needed to evaluate the efficacy of specific and general exercise therapies in this patient population, as there is currently insufficient evidence to support or refute the use of specific exercise strategies.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
4/4
Introduction
4/4
Accessing Data
4/4
Analysing Data
4/4
Results
4/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
The effectiveness of specific exercise strategies in the management of subacromial impingement syndrome has not been conclusively demonstrated, as clinical trials have provided conflicting results. A systematic review and meta-analysis were needed to provide the best estimate of effect for this treatment strategy based on available clinical evidence.
主な研究課題は何ですか？
In the management of subacromial impingement, is there any significant difference in treatment efficacy between a specific shoulder exercise program and a general shoulder exercise program?
重要な知見は？
- No significant difference between specific exercise and general exercise was observed in pain during activity after 4-8 weeks (4 studies; SMD -0.19 [95%CI -0.61, 0.22]; p=0.37; I^2=29%).
- No significant difference between specific exercise and general exercise was observed in function after 4-8 weeks (5 studies; SMD 0.30 [95%CI -0.16, 0.76]; p=0.20; I^2=58%).
最も覚えておくべきことは？
In the management of subacromial impingement syndrome, there was no significant difference in short-term pain and function between those who participated in a specific exercise program and those who participated in a general exercise program.
それが私の患者ケアにどのように影響するか？
The available evidence on the topic suggested that short-term outcomes are similar between a specific exercise program, consisting of specific scapular or proprioceptive exercises, and a general resistance exercise program for the management of subacromial impingement syndrome. Further work is necessary to evaluate if the length of program or duration of exercise sessions significantly impacts the efficacy of either strategy.
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