School of Allied Health Professions, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
BMC Musculoskelet Disord. 2013 Jul 8;14:203. doi: 10.1186/1471-2474-14-203.
People suffering from musculoskeletal shoulder pain are frequently referred to physiotherapy. Physiotherapy generally involves a multimodal approach to management that may include; exercise, manual therapy and techniques to reduce pain. At present it is not possible to predict which patients will respond positively to physiotherapy treatment. The purpose of this systematic review was to identify which prognostic factors are associated with the outcome of physiotherapy in the management of musculoskeletal shoulder pain.
A comprehensive search was undertaken of Ovid Medline, EMBASE, CINAHL and AMED (from inception to January 2013). Prospective studies of participants with shoulder pain receiving physiotherapy which investigated the association between baseline prognostic factors and change in pain and function over time were included. Study selection, data extraction and appraisal of study quality were undertaken by two independent assessors. Quality criteria were selected from previously published guidelines to form a checklist of 24 items. The study protocol was prospectively registered onto the International Prospective Register of Systematic Reviews.
A total of 5023 titles were retrieved and screened for eligibility, 154 articles were assessed as full text and 16 met the inclusion criteria: 11 cohort studies, 3 randomised controlled trials and 2 controlled trials. Results were presented for the 9 studies meeting 13 or more of the 24 quality criteria. Clinical and statistical heterogeneity resulted in qualitative synthesis rather than meta-analysis. Three studies demonstrated that high functional disability at baseline was associated with poor functional outcome (p ≤ 0.05). Four studies demonstrated a significant association (p ≤ 0.05) between longer duration of shoulder pain and poorer outcome. Three studies, demonstrated a significant association (p ≤ 0.05) between increasing age and poorer function; three studies demonstrated no association (p > 0.05).
Associations between prognostic factors and outcome were often inconsistent between studies. This may be due to clinical heterogeneity or type II errors. Only two baseline prognostic factors demonstrated a consistent association with outcome in two or more studies; duration of shoulder pain and baseline function. Prior to developing a predictive model for the outcome of physiotherapy treatment for shoulder pain, a large adequately powered prospective cohort study is required in which a broad range of prognostic factors are incorporated.
患有肌肉骨骼肩部疼痛的人经常被转介到物理治疗。物理治疗通常涉及管理的多模式方法，可能包括：运动，手法治疗和减轻疼痛的技术。目前，无法预测哪些患者对物理治疗治疗有积极反应。本系统评价的目的是确定与肌肉骨骼肩部疼痛的物理治疗结果相关的哪些预后因素。
对 Ovid Medline、EMBASE、CINAHL 和 AMED（从开始到 2013 年 1 月）进行了全面检索。纳入了接受物理治疗的肩部疼痛参与者的前瞻性研究，这些研究调查了基线预后因素与随时间推移的疼痛和功能变化之间的关联。两名独立评估人员进行了研究选择、数据提取和研究质量评估。质量标准选自以前发表的指南，形成了 24 项的检查表。该研究方案已在国际系统评价前瞻性登记处进行了前瞻性登记。
共检索到 5023 个标题，并对其进行了资格筛选，有 154 篇文章被评估为全文，16 篇符合纳入标准：11 项队列研究、3 项随机对照试验和 2 项对照试验。对符合 13 项或更多 24 项质量标准的 9 项研究进行了结果报告。临床和统计学异质性导致定性综合而非荟萃分析。三项研究表明，基线时功能障碍较高与功能结局不良相关（p≤0.05）。四项研究表明，肩痛持续时间较长与预后较差之间存在显著关联（p≤0.05）。三项研究表明，年龄增长与功能下降之间存在显著关联（p≤0.05）；三项研究表明无关联（p＞0.05）。
预后因素与结局之间的关联在研究之间往往不一致。这可能是由于临床异质性或 II 型错误。只有两个基线预后因素在两项或更多研究中与结局有一致的关联：肩痛持续时间和基线功能。在为肩部疼痛的物理治疗治疗结果制定预测模型之前，需要进行一项大型、充分有力的前瞻性队列研究，其中纳入广泛的预后因素。
