Griffin Jake, Jaggi Anju, Daniell Helena, Chester Rachel
Bexley MSK, Oxleas NHS Foundation Trust, Erith and District Hospital, Erith, DA8 3EE, UK.
School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Shoulder Elbow. 2023 Aug;15(4):448-460. doi: 10.1177/17585732221080730. Epub 2022 Feb 18.
Optimal physiotherapy treatment is uncertain for atraumatic shoulder instability (ASI), the primary aim of this systematic scoping review was to compare physiotherapy treatment programmes for people with ASI. The secondary aims were to evaluate outcome measures used and to compare the effectiveness of these programmes.
CINAHL, EMBASE and Medline databases were searched for studies, except single case studies, published between 1950 and July 2021. 12 critical appraisal items covered three domains; internal validity, transferability to wider population and reporting.
Ten studies were included; one randomised controlled trial, 6 cohort studies and 3 case series. There were 491 participants. Treatment programmes included education, movement re-education, static posture correction, shoulder muscle strengthening, functional training, and adjuncts. All studies used patient reported outcome measures (PROMs), 7 of which reported a statistically significant improvement ( < 0.05) post-treatment. There was no clear relationship between programmes and outcomes. PROMs specific to shoulder instability were all found to detect statistically significant differences post-treatment.
There does not appear to be one optimal physiotherapy treatment programme for ASI. Future studies should use PROMs that are valid in the shoulder instability population and use more outcome measures that are specific to impairments being targeted.
对于非创伤性肩关节不稳定（ASI），最佳物理治疗方案尚不确定。本系统综述的主要目的是比较针对ASI患者的物理治疗方案。次要目的是评估所使用的结局指标，并比较这些方案的有效性。
检索了CINAHL、EMBASE和Medline数据库，查找1950年至2021年7月间发表的研究，但单病例研究除外。12项关键评估项目涵盖三个领域：内部效度、向更广泛人群的可转移性和报告情况。
纳入10项研究；1项随机对照试验、6项队列研究和3个病例系列。共有491名参与者。治疗方案包括教育、运动再教育、静态姿势矫正、肩部肌肉强化、功能训练及辅助治疗。所有研究均使用患者报告结局指标（PROMs），其中7项报告治疗后有统计学显著改善（<0.05）。方案与结局之间没有明确的关系。所有针对肩关节不稳定的PROMs均发现治疗后有统计学显著差异。
对于ASI，似乎不存在一种最佳的物理治疗方案。未来的研究应使用在肩关节不稳定人群中有效的PROMs，并使用更多针对所针对损伤的结局指标。
