Pieters L, Lewis J, Kuppens K, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020 Mar;50(3):131-141. doi: 10.2519/jospt.2020.8498. Epub 2019 Nov 15. (Systematic review)

OBJECTIVE: To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain.

DESIGN: Umbrella review.

LITERATURE SEARCH: An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews.

STUDY SELECTION CRITERIA: Nonsurgical treatments for subacromial shoulder pain.

DATA SYNTHESIS: Sixteen systematic reviews were retrieved. Results were summarized qualitatively.

RESULTS: A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.

CONCLUSION: There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.

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

Physician rater

The paper supports the growing evidence about the effectiveness of conservative treatment and delay of surgical intervention, or avoidance of it except in well selected cases.

Rehab Clinician (OT/PT) rater

This is a good quality review that brings together current state of knowledge in a coherent and easy to interpret manner.

Rehab Clinician (OT/PT) rater

This is a great article, which evaluated the literature to support the best practice pattern. It appears that there is limited evidence to support the use of modalities and that manual therapy and exercise is most beneficial. It was unfortunately not clear what exactly manual therapy included. The variety of techniques almost makes this a multimodal tx approach as well.

Rehab Clinician (OT/PT) rater

This systematic literature review update reinforces the role of resistance exercises with progressive loads in the treatment of shoulder pain related to the subacromial space. The update reaffirms the role of manual therapy in the initial phase of exercise-based intervention. Physical modalities still do not reach sufficient evidence to be considered as part of the shoulder pain rehabilitation protocols.
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