Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: a systematic review and meta-analysis / Julie Bury, Morgan West, Gema Chamorro-Moriana, Chris Littlewood

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Continuing resourceISSN: 1356-689XSubject(s): scapula | rotator cuff | rehabilitation | exercise | systematic review In: Manual Therapy -- 2016, v 25, p. 35-42Summary: 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. Design: 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 to 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 to 16.8) in the short term (< 6weeks). 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. Conclusion: 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.

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Previous	PP Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized control trial /	PP Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial /	PP Do isometric pull-down exercises increase the acromio-humeral distance? /	PP Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: a systematic review and meta-analysis /	PP Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial /	PP Electromyographic analysis of the three subdivisions of gluteus medius during weight-bearing exercises /	PP Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men /	Next

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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.
Design: 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 to 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 to 16.8) in the short term (< 6weeks). 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.
Conclusion: 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.

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