Goldgrub Rachel, Côté Pierre, Sutton Deborah, Wong Jessica J, Yu Hainan, Randhawa Kristi, Varatharajan Sharanya, Southerst Danielle, Mior Silvano, Shearer Heather M, Jacobs Craig, Stupar Maja, Chung Chadwick L, Abdulla Sean, Balogh Robert, Dogra Shilpa, Nordin Margareta, Taylor-Vaisey Anne
Graduate Student, Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada.
Canada Research Chair in Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Oshawa, ON, Canada; Associate Professor, Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada; Director, UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada.
J Manipulative Physiol Ther. 2016 Feb;39(2):121-139.e1. doi: 10.1016/j.jmpt.2016.01.002.
The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder.
We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias.
We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections.
The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.
本系统评价旨在评估多模式护理对肩部软组织损伤管理的有效性。
我们进行了一项系统评价，并检索了1990年至2015年期间的MEDLINE、EMBASE、CINAHL、PsycINFO以及Cochrane对照试验中央注册库。两名独立评审员使用苏格兰跨学院指南网络标准对研究进行严格评估。我们采用最佳证据综合法来综合偏倚风险较低的研究中的证据。
我们筛选了5885篇文章，其中19篇符合严格评估标准。十项随机对照试验的偏倚风险较低。对于持续性肩峰下撞击综合征，多模式护理与假治疗、放射状体外冲击波治疗或手术的效果相似。对于肩峰下撞击综合征，与皮质类固醇注射相比，多模式护理可能在疼痛和功能方面带来微小且无临床重要意义的改善。对于肩袖肌腱炎，基于饮食的多模式护理可能比传统多模式护理（运动、软组织和手法治疗以及安慰剂片）更有效。对于非特异性肩部疼痛，多模式护理可能比等待名单或全科医生的常规护理更有效，但与运动或皮质类固醇注射的效果相似。
目前的证据表明，将多种干预措施整合到一个护理方案中，对于肩峰下撞击综合征或非特异性肩部疼痛患者并不会带来更好的结果。一项随机对照试验表明，基于饮食的多模式护理（饮食建议、针灸和酶片）可能比传统多模式护理提供更好的结果。然而，这些结果需要重复验证。
