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Meta-Analysis
. 2017 Apr 17;18(1):158.
doi: 10.1186/s12891-017-1518-0.

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

Alison R Shire  1 , Thor A B Stæhr  2 , Jesper B Overby  2 , Mathias Bastholm Dahl  2 , Julie Sandell Jacobsen  2 , David Høyrup Christiansen  3
Affiliations
Meta-Analysis

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

Alison R Shire et al. BMC Musculoskelet Disord. .

Abstract

Background: Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome.

Methods: Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate.

Results: Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function.

Conclusions: There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area.

Keywords: Function; Impingement; Pain; Physiotherapy; Shoulder; Subacromial; Training.

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Figures

Fig. 1
Fig. 1
PRISMA flow chart of inclusion of studies. The flow of the search and selection process in this systematic review and meta-analysis of specific exercises for patients with subacromial impingement syndrome. Review Manager (RevMan) 5.3 [44, 71]
Fig. 2
Fig. 2
Risk of bias summary. This graph illustrates the review authors assessment of each risk of bias domain for the six included studies. Review Manager (RevMan) 5.3 [44]
Fig. 3
Fig. 3
Risk of bias summary. This graph illustrates the review authors assessment of each risk of bias domain presented as percentages for the six included studies. Review Manager (RevMan) 5.3 [44]
Fig. 4
Fig. 4
Data and forest plot illustrating results of specific exercise versus general exercise for short term pain during activity (4–8 weeks) [–56]
Fig. 5
Fig. 5
Data and forest plot illustrating results of specific exercise versus general exercise for short term function (4–8 weeks) [–57]
See this image and copyright information in PMC

References

    1. Van der Windt D, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis. 1995;54(12):959–964. doi: 10.1136/ard.54.12.959. - DOI - PMC - PubMed
    1. Roquelaure Y, Ha C, Leclerc A, Touranchet A, Sauteron M, Melchior M, Imbernon E, Goldberg M. Epidemiologic surveillance of upper‐extremity musculoskeletal disorders in the working population. Arthritis Care Res. 2006;55(5):765–778. doi: 10.1002/art.22222. - DOI - PubMed
    1. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124–1128. doi: 10.1136/bmj.331.7525.1124. - DOI - PMC - PubMed
    1. Neer CS. Impingement lesions. Clin Orthop Relat Res. 1983;173:70–77. - PubMed
    1. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am. 1972;54(1):41–50. doi: 10.2106/00004623-197254010-00003. - DOI - PubMed

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