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Meta-Analysis
. 2019 May 29;14(5):e0216961.
doi: 10.1371/journal.pone.0216961. eCollection 2019.

The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis

Goris Nazari  1   2 , Joy C MacDermid  1   3 , Dianne Bryant  1   2 , George S Athwal  2   3
Affiliations
Meta-Analysis

The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis

Goris Nazari et al. PLoS One. .

Abstract

Objective: To assess the effectiveness of surgical vs conservative interventions on pain and function in patients with subacromial impingement syndrome.

Design: Systematic review and meta-analysis of randomized controlled trials.

Setting: Clinical setting.

Participants: Patients 18 years and older with subacromial impingement syndrome.

Intervention/comparison: Surgical intervention plus postoperative physiotherapy / placebo surgery plus physiotherapy or physiotherapy only.

Main outcome measures: Pain and function.

Results: 11 RCTs (n = 919) were included. The pooled results displayed no statistically or clinically different between surgery plus physiotherapy vs physiotherapy alone on pain levels at 3-, 6-months, 5- and 10 years follow up (moderate quality, 3 RCTs, 300 patients, WMD -0.39, 95% CI: -1.02 to 0.23, p = 0.22; moderate quality, 3 RCTs, 310 patients, WMD -0.36, 95% CI: -1.02 to 0.29, p = 0.27; low quality, 1 RCT, 109 patients, WMD -0.30, 95% CI: -1.54 to 0.94, p = 0.64; low quality, 1 RCT, 90 patients, WMD -1.00, 95% CI: -0.24 to 2.24, p = 0.11) respectively. Similarly, the pooled results were not statistically or clinically different between groups for function at 3-, 6-month and 1-year follow ups (very low quality, 2 RCTs, 184 patients, SMD 0.11, 95% CI: -0.57 to 0.79, p = 0.75; moderate quality, 3 RCTs, 310 patients, SMD 0.15, 95% CI: -0.14 to 0.43, p = 0.31; very low quality, 2 RCTs, 197 patients, SMD 0.11, 95% CI: -0.46 to 0.69, p = 0.70) respectively.

Conclusion: The effects of surgery plus physiotherapy compared to physiotherapy alone on improving pain and function are too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Selection of studies for inclusion in the systematic review.
Fig 2
Fig 2. Risk of bias summary: Review authors’ judgements about each risk of bias item for each included study.
Fig 3
Fig 3. Forest plot of comparison: Surgery plus physiotherapy vs Physiotherapy alone, outcome: Pain (0–10 VAS).
Lower values indicate improved pain.
Fig 4
Fig 4. Forest plot of comparison: Surgery plus physiotherapy vs Physiotherapy alone, outcome: Function (0–100).
Higher values indicate improved Function.
Fig 5
Fig 5. Forest plot of comparison: Surgery plus physiotherapy vs Placebo surgery plus Physiotherapy, outcome: Pain (0–10 VAS).
Lower values indicate improved Pain.
Fig 6
Fig 6. Forest plot of comparison: Surgery plus physiotherapy vs Placebo surgery plus physiotherapy, outcome: Function (0–100).
Higher values indicate improved Function.
See this image and copyright information in PMC

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