title: Consensus for physiotherapy for shoulder pain.
abstract: OBJECTIVE
  Shoulder pain is a common disorder. Despite growing evidence of the importance of physiotherapy, in particular active exercise therapy, little data is available to guide treatment. The aim of this project was to contribute to the development of an internationally accepted assessment and treatment algorithm for patients with shoulder pain.
  
  
  METHODS
  Nine physiotherapists with expertise in the treatment of shoulder dysfunction met in Sweden 2012 to begin the process of developing a treatment algorithm. A questionnaire was completed prior to the meeting to guide discussions. Virtual conferences were thereafter the platform to reach consensus.
  
  
  RESULTS
  Consensus was achieved on a clinical reasoning algorithm to guide the assessment and treatment for patients presenting with local shoulder pain, without significant passive range of motion deficits and no symptoms or signs of instability. The algorithm emphasises that physiotherapy treatment decisions should be based on physical assessment findings and not structural pathology, that active exercises should be the primary treatment approach, and that regular re-assessment is performed to ensure that all clinical features contributing to the presenting shoulder pain are addressed. Consensus was also achieved on a set of guiding principles for implementing exercise therapy for shoulder pain, namely, a limited number of exercises, performed with appropriate scapulo-humeral coordination and humeral head alignment, in a graduated manner without provoking the presenting shoulder pain.
  
  
  CONCLUSIONS
  The assessment and treatment algorithm presented could contribute to a more formal, extensive process aimed at achieving international agreement on an algorithm to guide physiotherapy treatment for shoulder pain.
authors.affiliation: Institution Neuroscience and Physiology/Physiotherapy, University of Gothenburg and Physiotherapy Department Sahlgrenska University Hospital, Gothenburg, Sweden, ingrid.hultenheim-klintberg@vgregion.se.
authors.forename: Ingrid Hultenheim
authors.initials: IH
authors.lastname: Klintberg
authors.forename: Ann M J
authors.initials: AM
authors.lastname: Cools
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Holmgren
authors.forename: Ann-Christine Gunnarsson
authors.initials: AC
authors.lastname: Holzhausen
authors.forename: Kajsa
authors.initials: K
authors.lastname: Johansson
authors.forename: Annelies G
authors.initials: AG
authors.lastname: Maenhout
authors.forename: Jane S
authors.initials: JS
authors.lastname: Moser
authors.forename: Valentina
authors.initials: V
authors.lastname: Spunton
authors.forename: Karen
authors.initials: K
authors.lastname: Ginn
mesh_terms: D000465:Algorithms; D032921:Consensus; D005081:Exercise Therapy; D006801:Humans; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000628:therapy*; D011795:Surveys and Questionnaires; D013548:Sweden