Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials.
OBJECTIVE
To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS).


METHODS
Systematic review.


METHODS
PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases.


METHODS
Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included.


RESULTS
64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet.


CONCLUSIONS
Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended.
Laboratory of Analysis and Intervention of the Shoulder Complex, Federal University of São Carlos, São Carlos, Brazil.
M N
MN
Haik
Salamanca Institute for Biomedical Research (IBSAL), Salamanca, Spain Department of Nursing and Physical Therapy, University of Salamanca, Salamanca, Spain.
F
F
Alburquerque-Sendín
Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil.
R F C
RF
Moreira
Laboratory of Analysis and Intervention of the Shoulder Complex, Federal University of São Carlos, São Carlos, Brazil.
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ED
Pires
Laboratory of Analysis and Intervention of the Shoulder Complex, Federal University of São Carlos, São Carlos, Brazil.
P R
PR
Camargo
D015670:Acupuncture Therapy; D003972:Diathermy; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D006801:Humans; D026201:Musculoskeletal Manipulations; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000628:therapy*
Exercise rehabilitation; Scapula; Shoulder