PAIN+ CPN

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.

Rehab Clinician (OT/PT) rater

This systematic review provides valuable insight into nonsurgical interventions for work-related shoulder pain; however, the conclusions are limited by the small number and low methodological quality of included trials. Although exercise-based approaches show uncertain short-term benefit, the primary contribution of this work lies in highlighting substantial gaps in the literature and the need for more rigorous standardized research. The article effectively underscores the importance of consistent terminology and improved study design to advance evidence-based practice in this area.

Prof. Mike Poling (11/6/2025 8:50 AM)

It's pretty clear that this is a very haphazard study. The exercise interventions are all over the place (inconsistent) and the intervention parameters were equally inconsistent. This is the equivalent of examining the effects of 25 different types of medications on diabetes and saying that diabetes medications are uncertain in their effectiveness. It matters WHAT the intervention is, how much of the intervention is used, how compliant participants are with the intervention, and how one intervention differs from another. Poor study and thus poor findings.