Maisonneuve-Rosemont Hospital Research Center, University of Montréal Affiliated Research Center, Montréal, Québec, Canada.
Department of Rehabilitation, Faculty of Medicine, Laval University, Québec City, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Québec, Canada.
Arch Phys Med Rehabil. 2020 Jul;101(7):1233-1242. doi: 10.1016/j.apmr.2019.12.017. Epub 2020 Jan 31.
To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults.
A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website.
Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers.
CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended."
Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization.
Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted.
对成人肩袖疾病管理的临床实践指南（CPG）进行系统评价，并对特定临床建议进行语义分析。
系统地检索了 Medline、Embase 和物理治疗证据数据库（PEDro）数据库，以及在评估研究和评估指南（AGREE）网站上列出的 12 个临床指南搜索引擎，检索时间截至 2018 年 5 月。
纳入了 9 篇关于成人或工人肩袖疾病管理的 CPG，这些 CPG 以英文或法文出版，且发表于 2008 年 1 月以后，并由 2 名独立评审员进行筛选和评估。
使用 AGREE II 清单评估 CPG 方法学。对基于其表述形式的相似建议进行了语义分析，以比较其强度。建议根据以下 4 个级别进行标准化分类：“必要”、“推荐”、“可能推荐”和“不推荐”。
有 3 篇 CPG 的方法学质量被认为较高，6 篇被认为较低。所有 CPG 都建议采用主动治疗方法，如在肩袖疾病管理中进行锻炼计划。对乙酰氨基酚或非甾体抗炎药处方和皮质类固醇注射被认为是可能推荐的止痛方法。关于医学影像和手术意见的建议在不同指南中有所不同。最常推荐的重返工作策略包括早期干预、采用多学科方法和调整工作组织。
只有 3 篇 CPG 的质量较高。有必要制定更严格的 CPG。
