Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA 02169, USA.
J Orthop Sports Phys Ther. 2011 Oct;41(10):734-48. doi: 10.2519/jospt.2011.3440. Epub 2011 Sep 4.
Systematic review with meta-analysis.
To pool and summarize the published research evidence examining if the combination of therapeutic exercise and joint mobilization is more beneficial than therapeutic exercise alone in patients with shoulder dysfunction.
Therapeutic exercise is an effective intervention for patients with shoulder dysfunction, which is often supplemented by joint mobilization techniques. Numerous studies have examined the effects of the combination of therapeutic exercise and joint mobilization on patients with shoulder dysfunction.
Six databases were searched for randomized controlled trials. All the randomized controlled trials published in English that have studied the effectiveness of therapeutic exercise and joint mobilization on adults with either clinically or radiographically confirmed shoulder dysfunction resulting in pain, restriction of range of motion (ROM), and/or limitation in function, were included in this review. Effect size was calculated in the form of standardized mean difference and 95% confidence interval (CI) for each variable, then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs.
Seven studies that met the inclusion criteria were identified, with a total of 290 participants. The WSMDs and CIs, which combined the results of all the studies for a particular variable, revealed equivocal results for all variables. The resulting WSMD (95% CI) for each of the variables was 0.2 (-0.68, 1.08) for pain, 0.15 (-0.67, 0.97) for abduction ROM, -0.04 (-0.65, 0.57) for flexion ROM, 0.01(-0.79, 0.81) for internal and external rotation ROM, and 0.09 (-0.46, 0.64) for function and disability. Even after elimination of sources of heterogeneity, the new WSMDs and CIs continued to overlap zero, giving equivocal results.
The current evidence is inconclusive with respect to the beneficial effects of the combination of therapeutic exercise and joint mobilization versus therapeutic exercise alone for reducing pain, increasing ROM and function, and limiting disability in patients with shoulder dysfunction.
Therapy, level 1a-.
系统评价与荟萃分析。
汇总和总结已发表的研究证据，以评估治疗性运动与关节松动术联合应用是否优于单纯治疗性运动在肩功能障碍患者中的疗效。
治疗性运动是治疗肩功能障碍的有效干预手段，常辅以关节松动技术。大量研究已经检验了治疗性运动与关节松动术联合应用于肩功能障碍患者的效果。
检索了 6 个数据库中的随机对照试验。本综述纳入了所有已发表的英文随机对照试验，这些试验研究了治疗性运动和关节松动术对有临床或影像学证实的肩功能障碍、疼痛、活动范围受限和/或功能受限的成年人的有效性，这些研究纳入了成年人。对每种变量的效应量以标准化均数差值和 95%置信区间（CI）的形式进行计算，然后合并以表示加权标准化均数差值（WSMD）和 95%CI。
确定了符合纳入标准的 7 项研究，共纳入 290 名参与者。合并所有研究结果的特定变量的 WSMD 和 CI 结果表明，所有变量的结果均不确定。每个变量的 WSMD（95%CI）分别为：疼痛 0.2（-0.68，1.08）、外展 ROM 0.15（-0.67，0.97）、屈曲 ROM-0.04（-0.65，0.57）、内旋和外旋 ROM 0.01（-0.79，0.81）、功能和残疾 0.09（-0.46，0.64）。即使消除了异质性来源，新的 WSMD 和 CI 仍继续与零重叠，结果不确定。
目前的证据尚不能确定治疗性运动与关节松动术联合应用与单纯治疗性运动相比，在减轻疼痛、增加 ROM 和功能以及限制肩功能障碍患者的残疾方面是否具有优势。
治疗，1a 级。
