Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration.
BACKGROUND
Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews reported conflicting results.


OBJECTIVE
The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder.


METHODS
MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013.


METHODS
Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias.


METHODS
The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data.


RESULTS
The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis.


CONCLUSIONS
Non-English studies were excluded.


CONCLUSIONS
Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham therapy for persistent shoulder calcific tendinitis.
H. Yu, MBBS, MSc, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; and Division of Graduate Education and Research, CMCC. Mailing address: UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, 6100 Leslie St, Toronto, Ontario, Canada, M2H 3J1. Hainan.Yu@uoit.ca.
Hainan
H
Yu
P. Côté, PhD, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation; Canada Research Chair in Disability Prevention and Rehabilitation, UOIT; and Faculty of Health Sciences, UOIT.
Pierre
P
Côté
H.M. Shearer, DC, MSc, FCCS(C), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Graduate Education and Research, CMCC.
Heather M
HM
Shearer
J.J. Wong, BSc, DC, FCCS(C), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation; Division of Graduate Education and Research, CMCC; and Division of Undergraduate Education, CMCC.
Jessica J
JJ
Wong
D.A. Sutton, MEd, MSc, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Graduate Education and Research, CMCC.
Deborah A
DA
Sutton
K.A. Randhawa, MPH, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Graduate Education and Research, CMCC.
Kristi A
KA
Randhawa
S. Varatharajan, MSc, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Graduate Education and Research, CMCC.
Sharanya
S
Varatharajan
D. Southerst, BScH, DC, FCCS(C), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Undergraduate Education, CMCC.
Danielle
D
Southerst
S.A. Mior, DC, PhD, Division of Graduate Education and Research, CMCC, and Faculty of Health Sciences, UOIT.
Silvano A
SA
Mior
A. Ameis, MD, FRCPC, DESS, DABPM&R, Certification Program in Insurance Medicine and Medico-legal Expertise, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
Arthur
A
Ameis
M. Stupar, DC, PhD, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Graduate Education and Research, CMCC.
Maja
M
Stupar
M. Nordin, DrMedSci, Department of Orthopedic Surgery, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York University, New York, New York.
Margareta
M
Nordin
G.M. van der Velde, DC, PhD, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada; Faculty of Pharmacy, Leslie Dan Pharmacy Building, University of Toronto; and Institute for Work and Health, Toronto, Ontario, Canada.
Gabreille M
GM
van der Velde
L. Carroll, PhD, School of Public Health, University of Alberta, Alberta, Canada.
Linda
L
Carroll
C.L. Jacobs, BFA, DC, MSc, FCCS(C), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, and Division of Clinical Education, CMCC.
Craig L
CL
Jacobs
A.L. Taylor-Vaisey, MLS, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation.
Anne L
AL
Taylor-Vaisey
S. Abdulla, BA, MSc, DC, Department of Graduate Studies, CMCC.
Sean
S
Abdulla
Y. Shergill, BSc, DC, Department of Graduate Studies, CMCC, and Department of Anesthesia, The Ottawa Hospital, Ottawa, Canada.
Yaadwinder
Y
Shergill
D006801:Humans; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D019534:Shoulder Impingement Syndrome / Q000150:complications / Q000628:therapy*; D000070599:Shoulder Injuries; D020069:Shoulder Pain / Q000209:etiology / Q000628:therapy*; D017695:Soft Tissue Injuries / Q000150:complications / Q000628:therapy; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome