How Effective Are Nonsurgical Interventions for Work-Related Shoulder Pain? A Systematic Review With Meta-Analysis of Randomized Controlled Trials

Abstract

OBJECTIVE: To evaluate the effectiveness of nonsurgical interventions for work-related shoulder pain. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials. DATA SOURCES: Six databases and 2 clinical trial registries were searched, supplemented by manual searches and citation tracking. Eligible trials compared nonsurgical interventions for work-related shoulder pain. DATA SYNTHESIS: Outcomes of interest were pain intensity, physical functioning, return to work, and productivity loss. Risk of bias was assessed using the Cochrane Risk of Bias tool 2.0; certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. A random-effects meta-analysis and narrative synthesis were performed. RESULTS: Of 8608 records identified, 24 randomized controlled trials met the inclusion criteria. Four trials were included in meta-analysis. No trials were at low risk of bias. The evidence was very uncertain (GRADE) regarding the effect of exercises interventions (eg, strengthening, stretching, and endurance exercises) compared to no intervention on short-term pain intensity (standardized mean difference, -0.60; 95% confidence interval: -1.22, 0.03; 95% prediction interval: -1.83, 0.64; k = 4; n = 172). Reanalyzing using 3 alternative meta-analysis approaches for small-study meta-analyses yielded different results. The narrative synthesis provided no additional insights. CONCLUSION: The evidence was very uncertain about whether exercise interventions (strengthening, stretching, and endurance) provided a moderate short-term (<3 months) benefit for reducing pain compared with no intervention. These results should be interpreted cautiously due to the limited number of trials included in the meta-analysis and the inconsistent terminology for work-related shoulder pain. J Orthop Sports Phys Ther 2025;55(11):1-14. Epub 3 October 2025. doi:10.2519/jospt.2025.13360.

Keywords: exercise; interventions; meta-analysis; shoulder pain; workers.