运动对肩峰下撞击综合征及其他肩部软组织损伤的管理有效吗？安大略省交通伤管理协议（OPTIMa）协作组的系统评价。
Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.
作者信息
Abdulla Sean Y, Southerst Danielle, Côté Pierre, Shearer Heather M, Sutton Deborah, Randhawa Kristi, Varatharajan Sharanya, Wong Jessica J, Yu Hainan, Marchand Andrée-Anne, Chrobak Karen, Woitzik Erin, Shergill Yaadwinder, Ferguson Brad, Stupar Maja, Nordin Margareta, Jacobs Craig, Mior Silvano, Carroll Linda J, van der Velde Gabrielle, Taylor-Vaisey Anne
机构信息
Department of Graduate Studies, Canadian Memorial Chiropractic College, Canada.
Division of Undergraduate Education, Canadian Memorial Chiropractic College, Canada; Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, Department of Medicine, Division of Rheumatology, Mount Sinai Hospital, Toronto, Canada; UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology and Canadian Memorial Chiropractic College, Canada.
出版信息
Man Ther. 2015 Oct;20(5):646-56. doi: 10.1016/j.math.2015.03.013. Epub 2015 Apr 1.
BACKGROUND
Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear.
OBJECTIVE
Determine the effectiveness of exercise for shoulder pain.
METHODS
We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology.
RESULTS
We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care.
CONCLUSION
The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care.
SYSTEMATIC REVIEW REGISTRATION NUMBER
CRD42013003928.
背景
运动是肩部软组织损伤康复的关键组成部分；然而其有效性仍不明确。
目的
确定运动对肩部疼痛的有效性。
方法
我们检索了1990年至2015年的七个数据库，以查找将运动与其他治疗肩部疼痛的干预措施进行比较的随机对照试验（RCT）、队列研究和病例对照研究。我们使用苏格兰校际指南网络（SIGN）标准对符合条件的研究进行严格评估。我们采用最佳证据综合方法对科学上可接受的研究结果进行综合分析。
结果
我们检索到4853篇文章。评估了11项随机对照试验，其中5项偏倚风险较低。4项研究涉及肩峰下撞击综合征。1项研究涉及非特异性肩部疼痛。对于不同病程的肩峰下撞击综合征：1）与等待治疗相比，监督下的强化训练能在短期内更有效地改善疼痛和功能障碍；2）与不治疗相比，监督下和家庭式的强化训练及伸展运动能在短期内更有效地改善疼痛和功能障碍。对于持续性肩峰下撞击综合征：1）监督下和家庭式的强化训练与手术效果相似；2）家庭式重负荷离心训练对家庭式肩袖强化训练和物理治疗并无额外益处。对于不同病程的轻度非特异性肩部疼痛，监督下的强化训练及伸展运动与皮质类固醇注射或多模式护理的短期效果相似。
结论
证据表明，监督下和家庭式的渐进性肩部强化训练及伸展运动对肩峰下撞击综合征的治疗有效。对于轻度非特异性肩部疼痛，监督下的强化训练及伸展运动与皮质类固醇注射或多模式护理同样有效。
系统评价注册号
CRD42013003928。
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