School of Physical Therapy, Western University, London, Canada.
Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Canada.
Disabil Rehabil. 2022 May;44(10):1766-1779. doi: 10.1080/09638288.2020.1811783. Epub 2020 Sep 15.
This systematic review evaluated and compared the effectiveness of non-surgical and surgical interventions for managing shoulder pain in patients with diabetes.
PubMed, Scopus, CINAHL, EMBASE, Sport Discus, and Cochrane library were searched for studies published in the last 20 years. Randomized clinical trials (RCTs) and cohort studies that assessed shoulder pain in patients with diabetes and implemented one or a combination of non-surgical and surgical interventions were eligible for inclusion. The quality of the included studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) tool. Data extracted from the eligible studies included study design, patient characteristics, duration of symptoms, type of interventions, outcome measures used to assess pain, follow-up intervals, and research findings.
A narrative synthesis with effect sizes (ES) or between-group differences was conducted. A total of 25 (14 non-surgical and 11 surgical) studies met the inclusion criteria. Six studies addressed physiotherapeutic interventions (three RCTs and three cohorts - ES = 0.07-1.3), three studies assessed the effect of steroid injections (two RCTs and one cohort - ES = 0.2-0.4), two cohorts addressed arthrographic capsular distension (between-group difference of 1.1 on Visual Analogue Scale), two cohorts addressed MUA, and one RCT addressed suprascapular nerve block (ES = 1-6). For the surgical studies, six cohorts addressed arthroscopic capsular release (ES = 0.2), three cohorts addressed arthroscopic rotator cuff repair (ES = 0.05-0.5), and one cohort addressed arthroplasty (ES = 0.3).
Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes.Implications For RehabilitationShoulder pain may lead to disability in patients with diabetes.We recommend the use of physiotherapy interventions to reduce shoulder pain.Corticosteroid injections are recommended for short-term shoulder pain relief.
本系统评价评估并比较了非手术和手术干预措施在治疗糖尿病患者肩部疼痛方面的有效性。
检索了过去 20 年发表的文献，包括 PubMed、Scopus、CINAHL、EMBASE、Sport Discus 和 Cochrane 图书馆。纳入了评估糖尿病患者肩部疼痛并实施一种或多种非手术和手术干预措施的随机临床试验（RCT）和队列研究。使用结构化有效性质量评估量表（SEQES）工具评估纳入研究的质量。从合格研究中提取的数据包括研究设计、患者特征、症状持续时间、干预类型、用于评估疼痛的结局测量、随访间隔和研究结果。
进行了叙述性综合分析，包括效应大小（ES）或组间差异。共有 25 项（14 项非手术和 11 项手术）研究符合纳入标准。6 项研究涉及物理治疗干预（3 项 RCT 和 3 项队列研究-ES=0.07-1.3），3 项研究评估了类固醇注射的效果（2 项 RCT 和 1 项队列研究-ES=0.2-0.4），2 项队列研究涉及关节造影囊扩张（视觉模拟评分的组间差异为 1.1），2 项队列研究涉及 MUA，1 项 RCT 涉及肩胛上神经阻滞（ES=1-6）。对于手术研究，6 项队列研究涉及关节镜下囊松解术（ES=0.2），3 项队列研究涉及关节镜下肩袖修复术（ES=0.05-0.5），1 项队列研究涉及关节置换术（ES=0.3）。
中等至极低质量证据表明，物理治疗加运动和肩胛上神经阻滞对改善糖尿病患者肩部疼痛有较大影响，而手术干预对改善肩部疼痛的效果较小。需要进行精心设计的未来研究，以提供这些干预措施对改善糖尿病患者肩部疼痛效果的准确估计。
肩部疼痛可能导致糖尿病患者残疾。我们建议使用物理治疗干预来减轻肩部疼痛。对于短期肩部疼痛缓解，建议使用皮质类固醇注射。
