Salamh PA, Liu X, Hanney WJ, et al. The efficacy and fidelity of clinical interventions used to reduce posterior shoulder tightness: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2019 Mar 19. pii: S1058-2746(18)30947-9. doi: 10.1016/j.jse.2018.12.006. (Systematic review)

BACKGROUND: Posterior shoulder tightness (PST) has been implicated in the etiology of numerous shoulder disorders and is a source of stiffness in both postoperative and nonsurgical cohorts. Identifying efficacious interventions to address PST has the potential to impact patient outcomes in both operative and nonoperative cohorts. Our purpose was to analyze the efficacy of nonoperative clinician-assisted interventions used to mitigate PST.

METHODS: We performed a systematic review and meta-analysis. Relevant studies were assessed for inclusion, and selected studies were identified from the PubMed, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases by a biomedical librarian. Data extracted from the selected studies underwent quality appraisal using Grading of Recommendations, Assessment, Development, and Evaluation analysis; fidelity assessment; and meta-analysis.

RESULTS: The search identified 374 studies, with 13 ultimately retained. Grading of Recommendations, Assessment, Development, and Evaluation analysis revealed areas of concern regarding consistency and imprecision of reporting within the included studies overall. Treatment fidelity assessment showed that only 3 of the 13 studies received a rating of good to excellent, indicating a high risk of bias. When clinician-assisted interventions were compared with no treatment, meta-analysis showed a moderate effect size in favor of clinician-assisted interventions for improving range of motion. When a multimodal treatment approach for PST was compared with active comparator interventions, a small effect size was present for improving range of motion in favor of the multimodal approach.

CONCLUSION: The efficacy of clinician-assisted interventions for reducing PST was identified when using both a single treatment and multimodal treatments. Current evidence focuses mostly on populations with PST who were not seeking care and the immediate- to short-term effects of clinician-assisted interventions, which may limit generalization of findings.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Rehab Clinician (OT/PT) rater

As a physical therapist, treating symptomatic populations with shoulder impairments, I found the article an interesting read but the authors did not provide any convincing evidence to change my intervention approach for managing patients with posterior shoulder tightness. I strongly recommend administering shoulder patient reported outcome functional status measures during the treatment episode to better judge how the patient from his or her perspective is responding to the intervention.
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