Steuri Ruedi, Sattelmayer Martin, Elsig Simone, Kolly Chloé, Tal Amir, Taeymans Jan, Hilfiker Roger
Department of Health, Bern University of Applied Sciences, Berne, Switzerland.
Department of Physiotherapy, University of Applied Sciences Western Switzerland, Leukerbad, Switzerland.
Br J Sports Med. 2017 Sep;51(18):1340-1347. doi: 10.1136/bjsports-2016-096515. Epub 2017 Jun 19.
To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement.
Systematic review and meta-analysis of randomised trials.
Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017.
Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments.
For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs.
Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise.
探讨保守干预措施对成人肩部撞击症患者疼痛、功能及活动范围的有效性。
随机试验的系统评价和荟萃分析。
检索了从建库至2017年1月的Medline、CENTRAL、CINAHL、Embase和PEDro数据库。
随机对照试验，纳入肩部撞击症患者，评估至少一种保守干预措施与假治疗或其他治疗的效果。
对于疼痛，运动疗法优于非运动对照干预措施（标准化均数差（SMD）-0.94，95%置信区间（CI）-1.69至-0.19）。特定运动疗法优于一般运动疗法（SMD -0.65，95%CI -0.99至-0.32）。皮质类固醇注射优于不治疗（SMD -0.65，95%CI -1.04至-0.26），超声引导注射优于非引导注射（SMD -0.51，95%CI -0.89至-0.13）。与安慰剂相比，非甾体抗炎药（NSAIDs）的SMD为-0.29，范围从小到中等（95%CI -0.53至-0.05）。手法治疗优于安慰剂（SMD -0.35，95%CI -0.69至-0.01）。当与运动疗法联合使用时，手法治疗优于单独运动疗法，但仅在最短随访期时如此（SMD -0.32，95%CI -0.62至-0.01）。激光治疗优于假激光治疗（SMD -0.88，95%CI -1.48至-0.27）。体外冲击波疗法（ECSWT）优于假治疗（-0.39，95%CI -0.78至-0.01），贴扎疗法优于假治疗（-0.64，95%CI -1.16至-0.12），SMD范围从小到中等。
尽管证据质量极低，但对于有肩部撞击症症状的患者应考虑运动疗法，可加用贴扎疗法、体外冲击波疗法、激光治疗或手法治疗。非甾体抗炎药和皮质类固醇优于安慰剂，但不清楚这些治疗与运动疗法相比效果如何。
