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Meta-analysis
ACE Report #9891

Specific vs general exercise program for treatment of subacromial impingement syndrome


Study Type:Meta-analysis/Systematic Review
OE Level Evidence:1
Journal Level of Evidence:N/A

Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis

BMC Musculoskelet Disord. 2017 Apr 17;18(1):158

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Synopsis

Six 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.

Publication Funding Details +
Funding:
Not Reported
Conflicts:
None disclosed

Risk of Bias

10/10

Reporting Criteria

20/20

Fragility Index

N/A

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?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.

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

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

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.

What was the principal research question?

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?

Study Characteristics -
Data Source:
PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Web of Science were searched for relevant articles.
Index Terms:
The search strategy included keywords: shoulder, scapula, subacromial, impingement, bursitis, tendinitis, tendonitis, rehabilitation, physiotherapy, physical therapy, exercise, and training. Full search strategies can be found in the appendix of the full text.
Study Selection:
Eligibility criteria included: a randomized controlled trial; enrolled patients over the age of 18 years with clinical signs of subacromial impingement syndrome; allocated patients to treatment with either a program of specific exercise strategies, such as scapular stabilization, positioning, proprioception, neuromuscular control, strengthening and stretching, or a program of general exercises incorporating resistance exercises. The selection was performed independently by two reviewers, with disagreement resolved by consensus. A total of six randomized controlled trials, with data sampled from 231 patients, were selected for final inclusion.
Data Extraction:
Data extraction was performed independently by two reviewers.
Data Synthesis:
Statistical analysis was performed using Review Manager software (RevMan 5.3). Standardized mean differences with 95% confidence intervals were calculated for continuous outcomes. A random-effects model was used. Heterogeneity was assessed using the I-squared (I^2) statistic.

What were the important findings?

  • 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%).

What should I remember most?

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.

How will this affect the care of my patients?

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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