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Naunton J, Street G, Littlewood C, et al. Effectiveness of progressive and resisted and non-progressive or non-resisted exercise in rotator cuff related shoulder pain: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2020 Sep;34(9):1198-1216. doi: 10.1177/0269215520934147. Epub 2020 Jun 22. (Systematic review)
Abstract

OBJECTIVE: Synthesize evidence regarding effectiveness of progressive and resisted or non-progressive and non-resisted exercise compared with placebo or no treatment, in rotator cuff related pain.

DATA SOURCES: English articles, searched in Cochrane CENTRAL, MEDLINE, EMBASE and CINAHL databases up until May 19, 2020.

METHODS: Randomized controlled trials in people with rotator cuff related pain comparing either progressive and resisted exercise or non-progressive and non-resisted exercise, with placebo or no treatment were included. Data extracted independently by two authors. Risk of bias appraised with the Cochrane Collaboration tool.

RESULTS: Seven trials (468 participants) were included, four trials (271 participants) included progressive and resisted exercise and three trials (197 participants) included non-progressive or non-resisted exercise. There was uncertain clinical benefit for composite pain and function (15 point difference, 95% CI 9 to 21, 100-point scale) and pain outcomes at >6 weeks to 6 months with progressive and resisted exercise compared to placebo or no treatment (comparison 1). For non-progressive or non-resisted exercise there was no significant benefit for composite pain and function (4 point difference, 95% CI -2 to 9, 100-point scale) and pain outcomes at >6 weeks to 6 months compared to placebo or no treatment (comparison 2). Adverse events were seldom reported and mild.

CONCLUSIONS: There is uncertain clinical benefit for all outcomes with progressive and resisted exercise and no significant benefit with non-progressive and non-resisted exercise, versus no treatment or placebo at >6 weeks to 6 months. Findings are low certainty and should be interpreted with caution.

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

Physician rater

The review is good but the conclusion in the abstract is poorly expressed and conflicts with the clinical message, which is somewhat better formulated. I do not recommend this article.

Rehab Clinician (OT/PT) rater

It seems that this review identifies a lack of true good evidence supporting the use of resistive and progressive exercise. It does identify that non progressive or non-non-reistive exercise is not beneficial. Better research should be performed to look at the benefit of resistive exercise with RCT related dysfunction.

Rehab Clinician (OT/PT) rater

This review included in the meta-analysis four trials (n = 271) of treatment with progressive and resisted exercises and three trials (n = 197) of non-progressive and non-resisted exercises. The conclusions are not exactly new, since the detailed description of the exercise protocols remains a challenge for this type of review and exercise-based therapy will always have a non-blinding participant bias.
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