Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
BACKGROUND
Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear.


OBJECTIVE
Determine the effectiveness of exercise for shoulder pain.


METHODS
We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology.


RESULTS
We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care.


CONCLUSIONS
The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care.
CRD42013003928.
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Sean Y
SY
Abdulla
Division of Undergraduate Education, Canadian Memorial Chiropractic College, Canada; Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada. Electronic address: dsoutherst@mtsinai.on.ca.
Danielle
D
Southerst
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Canada.
Pierre
P
Côté
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Heather M
HM
Shearer
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Deborah
D
Sutton
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Kristi
K
Randhawa
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Sharanya
S
Varatharajan
Division of Undergraduate Education, Canadian Memorial Chiropractic College, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Jessica J
JJ
Wong
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Hainan
H
Yu
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Andrée-Anne
AA
Marchand
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Karen
K
Chrobak
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Erin
E
Woitzik
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada; Department of Anaesthesia, The Ottawa Hospital, Canada.
Yaadwinder
Y
Shergill
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Brad
B
Ferguson
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Maja
M
Stupar
Departments of Orthopedic Surgery and Environmental Medicine, NYU School of Medicine, New York University, USA.
Margareta
M
Nordin
Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada; Division of Clinical Education, Canadian Memorial Chiropractic College, Canada.
Craig
C
Jacobs
Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Canada.
Silvano
S
Mior
Department of Public Health Sciences, Injury Prevention Centre, School of Public Health, University of Alberta, Canada.
Linda J
LJ
Carroll
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada; Faculty of Pharmacy, University of Toronto, Canada; Institute for Work and Health, Canada.
Gabrielle
G
van der Velde
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada.
Anne
A
Taylor-Vaisey
D019468:Disease Management; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario; D010147:Pain Measurement; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D019534:Shoulder Impingement Syndrome / Q000175:diagnosis / Q000534:rehabilitation*; D020069:Shoulder Pain / Q000175:diagnosis / Q000534:rehabilitation*; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome
Exercise; Shoulder pain; Subacromial impingement syndrome; Systematic review