Efficacy comparison between acupuncture and other modalities in the treatment of rotator cuff diseases: meta-analysis of randomized controlled trials

Abstract

Objective: This study aimed to analyze the efficacy of acupuncture alone or combined with physical therapy compared to other treatment interventions for relieving pain and improving function in rotator cuff diseases.

Methods: Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After PROSPERO (CRD42023396740) registration, all randomized controlled trials (RCTs) published from the inception of the databases to October 10, 2023, evaluating the efficacy of acupuncture either alone or in combination with physical therapy for treating rotator cuff diseases, were extracted from seven databases, including PubMed, Embase, the Web of Science, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), and the Wanfang Date. Two independent researchers assessed the quality of the included studies and extracted relevant data. Furthermore, a meta-analysis was conducted using Stata 14 software.

Results: We included 13 RCTs - 12 published in English and 1 in Chinese - that enrolled 1,371 patients. The meta-analysis results demonstrated that acupuncture alone or in combination with physical therapy was superior to other interventions for short-term shoulder joint function improvement (standardized mean difference [SMD] = -0.82, 95% confidence interval [95% CI]: -1.28 to -0.35, P = 0.001), medium-term shoulder joint function improvement (SMD = -1.00, 95% CI: -1.62 to -0.38, P = 0.002), short-term pain relief (weighted mean difference [WMD] = -1.37, 95% CI: -2.39 to -0.38, P = 0.006), medium-term pain relief (WMD = -1.66, 95% CI: -2.70 to -0.63, P = 0.002), and post-treatment shoulder joint abduction improvements (SMD = 0.68, 95% CI: 0.20 to 1.16, P = 0.005), external rotation (SMD = 0.62, 95% CI: 0.13 to 1.11, P = 0.012), and forward flexion (SMD = 0.71, 95% CI: 0.44 to 0.97, P < 0.001), with significant differences (P < 0.05).

Conclusion: Based on the current clinical data, meta-analysis showed that acupuncture alone or combined with physical therapy is efficacious for short- and medium-term (< 3 months) pain relief and functional improvements. However, compared to other interventions, the efficacy of the long-term (3 to 12 months) period did not significantly differ. After treatment, these modalities displayed advantages such as improved shoulder joint abduction, external rotation, and forward flexion movements. However, no significant difference was noted in internal rotation movement. Thus, future studies might further investigate whether different acupuncture methods affect the efficacy of treating rotator cuff diseases and improving long-term outcome.

Keywords: Acupuncture; meta-analysis; physical therapy; rotator cuff diseases; rotator cuff injury; subacromial pain syndrome.

Figure 1

Literature search and screening process.

Figure 2

Summary of bias risk assessment: a review of the judgment for each bias risk in all included studies. Red (-): high risk of bias, Yellow (?): Bias risk unclear, Green (+): Low bias risk.

Figure 3

Bias risk chart: a retrospective review of the judgment for each bias risk in all included studies, represented as percentages.

Figure 4

Forest plot for observing the improvement in functional score associated with acupuncture, exercise rehabilitation, or their combination compared to other interventions for treating rotator cuff diseases in the short, medium, and long-term periods.

Figure 5

Forest plot for pain reduction in the short-, medium-, and long-term periods with acupuncture, exercise rehabilitation, or their combination when compared to other interventions for rotator cuff diseases.

Figure 6

Forest plot for shoulder joint abduction improvement after treatment with acupuncture, exercise rehabilitation, or their combination when compared to other interventions for managing rotator cuff diseases.

Figure 7

Forest plot for shoulder joint external rotation improvement after treatment with acupuncture, exercise rehabilitation, or their combination in comparison to other interventions for managing rotator cuff diseases.

Figure 8

Forest plot for shoulder joint flexion improvement after treatment with acupuncture, exercise rehabilitation, or their combination compared to other interventions for rotator cuff diseases.

Figure 9

Forest plot for shoulder joint internal rotation improvement after treatment with acupuncture, exercise rehabilitation, or their combination when compared to other interventions for treating rotator cuff diseases.

Figure 10

Funnel plot of publication bias for pain reduction.

Figure 11

Funnel plot of publication bias for function improvement.