Hawk Cheryl, Minkalis Amy L, Khorsan Raheleh, Daniels Clinton J, Homack Dennis, Gliedt Jordan A, Hartman Julie A, Bhalerao Shireesh
Texas Chiropractic College, Pasadena, TX.
Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
J Manipulative Physiol Ther. 2017 Jun;40(5):293-319. doi: 10.1016/j.jmpt.2017.04.001. Epub 2017 May 26.
The purpose of this review was to evaluate the effectiveness of conservative nondrug, nonsurgical interventions, either alone or in combination, for conditions of the shoulder.
The review was conducted from March 2016 to November 2016 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered with PROSPERO. Eligibility criteria included randomized controlled trials (RCTs), systematic reviews, or meta-analyses studying adult patients with a shoulder diagnosis. Interventions qualified if they did not involve prescription medication or surgical procedures, although these could be used in the comparison group or groups. At least 2 independent reviewers assessed the quality of each study using the Scottish Intercollegiate Guidelines Network checklists. Shoulder conditions addressed were shoulder impingement syndrome (SIS), rotator cuff-associated disorders (RCs), adhesive capsulitis (AC), and nonspecific shoulder pain.
Twenty-five systematic reviews and 44 RCTs met inclusion criteria. Low- to moderate-quality evidence supported the use of manual therapies for all 4 shoulder conditions. Exercise, particularly combined with physical therapy protocols, was beneficial for SIS and AC. For SIS, moderate evidence supported several passive modalities. For RC, physical therapy protocols were found beneficial but not superior to surgery in the long term. Moderate evidence supported extracorporeal shockwave therapy for calcific tendinitis RC. Low-level laser was the only modality for which there was moderate evidence supporting its use for all 4 conditions.
The findings of this literature review may help inform practitioners who use conservative methods (eg, doctors of chiropractic, physical therapists, and other manual therapists) regarding the levels of evidence for modalities used for common shoulder conditions.
本综述的目的是评估单独或联合使用的保守非药物、非手术干预措施对肩部疾病的有效性。
本综述于2016年3月至2016年11月按照系统评价和Meta分析的首选报告项目（PRISMA）进行，并在PROSPERO注册。纳入标准包括研究肩部诊断成年患者的随机对照试验（RCT）、系统评价或Meta分析。干预措施符合条件，如果它们不涉及处方药或手术程序，尽管这些可以用于对照组。至少2名独立评审员使用苏格兰跨学院指南网络清单评估每项研究的质量。涉及的肩部疾病有肩部撞击综合征（SIS）、肩袖相关疾病（RCs）、粘连性关节囊炎（AC）和非特异性肩部疼痛。
25项系统评价和44项RCT符合纳入标准。低至中等质量的证据支持对所有4种肩部疾病使用手法治疗。运动，特别是与物理治疗方案相结合，对SIS和AC有益。对于SIS，中等证据支持几种被动治疗方式。对于RC，发现物理治疗方案有益，但从长期来看并不优于手术。中等证据支持体外冲击波疗法治疗钙化性肌腱炎RC。低强度激光是唯一有中等证据支持用于所有4种疾病的治疗方式。
本文献综述的结果可能有助于为使用保守方法的从业者（如整脊医生、物理治疗师和其他手法治疗师）提供有关常见肩部疾病治疗方式证据水平的信息。
