title: Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: A systematic review and meta-analysis.
abstract: BACKGROUND
  Rotator cuff related shoulder pain (RCSP) is common with a range of conservative treatments currently offered. Evidence supporting superiority of one approach over another is lacking. Scapula focused approaches (SFA) are frequently prescribed and warrant investigation.
  
  
  OBJECTIVE
  To evaluate the effectiveness of SFA in RCSP.
  
  
  METHODS
  Systematic review of randomised controlled trials.
  
  
  METHODS
  An electronic search including MEDLINE, PEDro, ENFISPO to January 2016 was supplemented by hand searching. Randomised controlled trials were included; appraised using the PEDro scale and synthesised via meta-analysis or narratively, where appropriate.
  
  
  RESULTS
  Four studies (n = 190) reported on pain and three studies (n = 122) reported on disability. Regarding pain, there was statistical but not clinically significant benefit of SFA versus generalised approaches (mean difference (VAS) 0.714; 95% CI 0.402-1.026) in the short term (<6 weeks); regarding disability, there was significant benefit of SFA versus generalised approaches (mean difference 14.0; 95% CI 11.2-16.8) in the short term (<6 weeks). One study (n = 22) reported disability at 3 months, which was not statistically significant. Evidence is conflicting from four studies relating to the effect of SFA on scapula position/movement.
  
  
  CONCLUSIONS
  SFA for RCSP confers benefit over generalised approaches up to six weeks but this benefit is not apparent by 3 months. Early changes in pain are not clinically significant. With regards to scapula position/movement, the evidence is conflicting. These preliminary conclusions should be treated with significant caution due to limitations of the evidence base.
authors.affiliation: Doncaster & Bassetlaw Hospitals, NHS Foundation Trust, Physiotherapy Dept., Doncaster Royal Infirmary, Doncaster, UK. Electronic address: julie.bury@nhs.net.
authors.forename: Julie
authors.initials: J
authors.lastname: Bury
authors.affiliation: Sherwood Forest, NHS Foundation Trust, Kings Mill Hospital, Mansfield, UK. Electronic address: Morgan.West@sfh-tr.nhs.uk.
authors.forename: Morgan
authors.initials: M
authors.lastname: West
authors.affiliation: Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatric, University of Seville, Spain. Electronic address: gchamorro@us.es.
authors.forename: Gema
authors.initials: G
authors.lastname: Chamorro-Moriana
authors.affiliation: School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK; Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. Electronic address: c.littlewood@sheffield.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Littlewood
mesh_terms: D005081:Exercise Therapy; D006801:Humans; D017006:Rotator Cuff / Q000503:physiopathology*; D012540:Scapula / Q000503:physiopathology*; D020069:Shoulder Pain / Q000175:diagnosis* / Q000534:rehabilitation*
keywords: Exercise; Rehabilitation; Rotator cuff; Scapula; Systematic review