医学
荟萃分析
体外冲击波疗法
安慰剂
物理疗法
随机对照试验
手法治疗
心理干预
最小临床重要差异
梅德林
内科学
替代医学
政治学
精神科
病理
法学
作者
Ruedi Steuri,Martin Sattelmayer,Simone Elsig,Chloé Kolly,Amir Tal,Jan Taeymans,Roger Hilfiker
标识
DOI:10.1136/bjsports-2016-096515
摘要
Objective
To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. Design
Systematic review and meta-analysis of randomised trials. Data sources
Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. Study selection criteria
Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. Results
For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) −0.94, 95% CI −1.69 to −0.19). Specific exercises were superior to generic exercises (SMD −0.65, 95% CI −0.99 to −0.32). Corticosteroid injections were superior to no treatment (SMD −0.65, 95% CI −1.04 to −0.26), and ultrasound guided injections were superior to non-guided injections (SMD −0.51, 95% CI −0.89 to −0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of −0.29 (95% CI −0.53 to −0.05) compared with placebo. Manual therapy was superior to placebo (SMD −0.35, 95% CI −0.69 to −0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD −0.32, 95% CI −0.62 to −0.01). Laser was superior to sham laser (SMD −0.88, 95% CI −1.48 to −0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (−0.39, 95% CI −0.78 to –0.01) and tape was superior to sham (−0.64, 95% CI −1.16 to −0.12), with small to moderate SMDs. Conclusion
Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.
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