Physiotherapy Interventions For Shoulder Pain: Cochrane Review Abstracts

Cochrane review abstracts 335
strate that the control and intervention sites are not Contact address
comparable with respect to the methodological Derek Ward, Clinical Research Fellow,
criteria specified by Cochrane EPOC group. The Portsmouth Institute of Medicine, Health and Social Care,
combined effect of these factors resulted in the com- University of Portsmouth, St Georges Building,
parability between intervention and control groups 141 High Street, Portsmouth, Hampshire, PO1 2HY.
being very weak. For example, there were differences Telephone 023 92 845245
in the services provided in the intervention and Fax 023 92 845200
control arms, due possibly to differences in dominant E-mail [email protected]
remuneration systems, nature of the rehabilitation
transformation, patient characteristics, skill mix and
academic status of the care environment.
Physiotherapy interventions for shoulder pain

S Green, R Buchbinder, S Hetrick
Background The prevalence of shoulder disorders two independent reviewers according to a list of
has been reported to range from seven to 36% of the predetermined criteria, which were based on the
population accounting for 1.2% of all general PEDro scale specifically designed for the assessment
practitioner encounters in Australia. Substantial of validity of trials of physiotherapy interventions.
disability and significant morbidity can result from Outcome data were extracted and entered into
shoulder disorders. While many treatments have been Revman 4.1. Means and standard deviations for
employed in the treatment of shoulder disorders, few continuous outcomes and number of events for
have been proven in randomised controlled trials. binary outcomes were extracted where available from
Physiotherapy is often the first line of management the published reports. All standard errors of the
for shoulder pain and to date its efficacy has not been mean were converted to standard deviations. For
established. This review is one in a series looking at trials where the required data were not reported or
varying interventions for shoulder disorders, updated not able to be calculated, further details were
from an earlier Cochrane review of all interventions requested from first authors. If no further details
for shoulder disorder. were provided, the trial was included in the review
and fully described, but not included in the meta-
Objectives To determine the efficacy of physio- analysis. Results were presented for each diagnostic
therapy for disorders resulting in pain, stiffness sub-group (rotator cuff disease, adhesive capsulitis,
and/or disability of the shoulder. etc) and where possible combined in meta-analysis to
give a treatment effect across all trials.
Search strategy Medline, Embase, the Cochrane
Clinical Trials Register and Cinahl were searched Main results Twenty-six trials met the inclusion
1966 to June 2002. The Cochrane Musculoskeletal criteria. Methodological quality was variable and trial
Review Group's search strategy was used and key populations were generally small (median sample size
words gained from previous reviews and all relevant = 48, range 14 to 180). Exercise was demonstrated to
articles were used as text terms in the search. be effective in terms of short-term recovery in rotator
cuff disease (relative risk 7.74 (1.97, 30.32)), and
Selection criteria Each identified study was assessed longer-term benefit with respect to function (relative
for possible inclusion by two independent reviewers. risk 2.45 (1.24, 4.86)). Combining mobilisation
The determinants for inclusion were that the trial be with exercise resulted in additional benefit when
of an intervention generally delivered by a physio- compared to exercise alone for rotator cuff disease.
therapist, that treatment allocation was randomised; Laser therapy was demonstrated to be more effective
and that the study population be suffering from a than placebo (relative risk 3.71 (1.89, 7.28)) for
shoulder disorder, excluding trauma and systemic adhesive capsulitis but not for rotator cuff tendinitis.
inflammatory diseases such as rheumatoid arthritis. Both ultrasound and pulsed electromagnetic field
therapy resulted in improvement compared to
Data collection and analysis The methodological placebo in pain in calcific tendinitis (relative risk 1.81
quality of the included trials was assessed by (1.26, 2.60) and relative risk 19 (1.16, 12.43)
respectively). There is no evidence of the effect of
Green, S, Buchbinder, R and Hetrick S (2003). ultrasound in shoulder pain (mixed diagnosis),
'Physiotherapy interventions for shoulder pain', The adhesive capsulitis or rotator cuff tendinitis. When
Cochrane Library, 2, Update Software, Oxford. compared to exercises, ultrasound is of no additional
Physiotherapy June 2003/vol 89/no 6

336
benefit over and above exercise alone. There is some pain, for shoulder pain where combinations of
evidence that for rotator cuff disease, corticosteroid physiotherapy interventions, and physiotherapy as an
injections are superior to physiotherapy and no adjunct to non-physiotherapy interventions are
evidence that physiotherapy alone is of benefit for compared. This is more reflective of current clinical
adhesive capsulitis. practice. Trials should be adequately powered and
address key methodological criteria such as allocation
Reviewers’ conclusions The small sample sizes, concealment and blinding of outcome assessor.
variable methodological quality and heterogeneity in
terms of population studied, physiotherapy employed Contact address
and length of follow-up of randomised controlled Associate Professor Sally Green, Director,
trials of physiotherapy interventions results in little Australasian Cochrane Centre, Monash University,
overall evidence to guide treatment. Australasian Cochrane Centre, Locked Bag 29,
There is evidence to support the use of some inter- Clayton 3168, Victoria, Australia.
ventions in specific and circumscribed cases. Telephone +61 3 9594 7531
There is a need for trials of physiotherapy for Fax +61 3 9594 7554
specific clinical conditions associated with shoulder E-mail [email protected]
Physiotherapy treatment approaches for the recovery of

postural control and lower limb function following stroke
A Pollock, G Baer, V Pomeroy, P Langhorne
Background There are a number of different app- Data collection and analysis Two independent
roaches to physiotherapy following stroke. Central to reviewers categorised the identified trials according to
these are approaches based on neurophysiological, the inclusion/exclusion criteria, documented the
motor learning and orthopaedic principles. methodological quality and extracted the data.
Objectives To determine whether there is a differ- Main results Eleven trials were included in the
ence in the recovery of postural control and lower review, three of which were included in two com-
limb function in patients with stroke if physiotherapy parisons. Four trials compared a neurophysiolog-
is based on orthopaedic or neurophysiological or ical approach with another approach; four trials
motor learning principles, or on a mixture of these. compared a motor learning approach with another
approach; four studies compared a mixed approach
Search strategy This review drew on the search with another approach, two trials reported compar-
strategy developed by the Stroke Group as a whole. isons of sub-groups of the same approach. A large
Relevant trials were identified in the Stroke Group number of heterogeneous outcome measures were
Trials Register of Controlled Trials which was last used, limiting the comparison of trial results. No one
searched in May 2001. We also searched the type of approach had a significantly better outcome
Cochrane Controlled Trials Register (Cochrane than any other.
Library, 4, 1999), Medline (1966-1999), Embase
(1980-1999) and Cinahl (1982-1999) and contacted Reviewers' conclusions There is not enough
experts and researchers with an interest in stroke. evidence to conclude that any one physiotherapy
approach is more effective than another in prom-
Selection criteria Studies – randomised or quasi- oting the recovery of postural control or lower limb
randomised controlled trials. Participants – adults function.
with a clinical diagnosis of stroke. Interventions –
physiotherapy treatment approaches aimed at Contact address
promoting the recovery of postural control and lower Dr Alex Pollock, Research Therapist,
limb function. Outcomes – measures of disability, Stroke Therapy Evaluation Programme,
motor impairment or participation. Academic Department of Geriatric Medicine,
University of Glasgow, Level 3, Centre Block,
Glasgow Royal Infirmary, Glasgow G4 OSF.
Pollock, A, Baer, G, Pomeroy, V and Langhorne, P (2003).
'Physiotherapy treatment approaches for the recovery of Telephone 0141 211 4953
postural control and lower limb function following stroke', Fax 0141 211 4944
The Cochrane Library, 2, Update Software, Oxford. E-mail [email protected]
Physiotherapy June 2003/vol 89/no 6

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Cochrane review abstracts 335

Physiotherapy interventions for shoulder pain

Physiotherapy June 2003/vol 89/no 6

Physiotherapy treatment approaches for the recovery of

Physiotherapy June 2003/vol 89/no 6

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