title: The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
abstract: OBJECTIVE
  The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder.
  
  
  METHODS
  We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias.
  
  
  RESULTS
  We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections.
  
  
  CONCLUSIONS
  The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.
authors.affiliation: Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Goldgrub
authors.affiliation: Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada. Electronic address: Pierre.Cote@uoit.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Research Associate, 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, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sutton
authors.affiliation: Research Associate, 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, ON, Canada; Associate Clinical Research Scientist, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Wong
authors.affiliation: Research Associate, 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, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Hainan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Research Associate, 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, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Kristi
authors.initials: K
authors.lastname: Randhawa
authors.affiliation: Research Associate, 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, ON, Canada; Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Instructor, Division of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
authors.forename: Sharanya
authors.initials: S
authors.lastname: Varatharajan
authors.affiliation: Research Coordinator, Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Southerst
authors.affiliation: Professor, Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Adjunct Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
authors.forename: Silvano
authors.initials: S
authors.lastname: Mior
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Clinical Research Manager, 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, ON, Canada; Senior Clinical Research Scientist, Graduate Education and Research Programs, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shearer
authors.affiliation: Director, Clinical Education and Patient Care, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Adjunct Professor, Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada; Postdoctoral Fellow, 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, ON, Canada.
authors.forename: Maja
authors.initials: M
authors.lastname: Stupar
authors.affiliation: Assistant to the Director, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Chadwick L
authors.initials: CL
authors.lastname: Chung
authors.affiliation: Graduate Student, Department of Graduate Studies, Canadian Memorial Chiropractic College (CMCC), Toronto, ON, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Abdulla
authors.affiliation: Assistant Professor, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Balogh
authors.affiliation: Assistant Professor, Faculty of Health Sciences, Kinesiology, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Dogra
authors.affiliation: Professor, Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center, NYU School of Medicine, New York, NY.
authors.forename: Margareta
authors.initials: M
authors.lastname: Nordin
authors.affiliation: Research Associate, 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, ON, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor-Vaisey
mesh_terms: D003131:Combined Modality Therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D026741:Physical Therapy Modalities; D000070599:Shoulder Injuries / Q000628:therapy*; D017695:Soft Tissue Injuries / Q000628:therapy*; D000078202:Systematic Reviews as Topic
chemical_list: D005938:Glucocorticoids
keywords: Combined Modality Therapy; Review Literature as Topic; Rotator Cuff; Shoulder Impingement Syndrome; Shoulder Pain; Soft Tissue Injuries; Tendinopathy