Faculty of Health Science and Medicine, Bond Institute of Health and Sport, Bond University, Robina, Queensland, Australia.
Therapy Department, Central London Community Healthcare National Health Service Trust, Finchley Memorial Hospital, London, UK.
Musculoskeletal Care. 2024 Jun;22(2):e1879. doi: 10.1002/msc.1879.
Exercise therapy is a popular non-surgical treatment to help manage individuals with rotator cuff-related shoulder pain (RCRSP) and is recommended in all clinical practice guidelines. Due to modest effect sizes, low quality evidence, uncertainty relating to efficacy, and mechanism(s) of benefit, exercise as a therapeutic intervention has been the subject of increasing scrutiny.
The aim of this critical review is to lay out where the purported uncertainties of exercise for RCRSP exist by exploring the relevant quantitative and qualitative literature. We conclude by offering theoretical and practical considerations to help reduce the uncertainty of delivering exercise therapy in a clinical environment.
Uncertainty underpins much of the theory and practice of delivering exercise therapy for individuals with RCRSP. Nonetheless, exercise is an often-valued treatment by individuals with RCRSP, when provided within an appropriate clinical context. We encourage clinicians to use a shared decision-making paradigm and embrace a pluralistic model when prescribing therapeutic exercise. This may take the form of using exercise experiments to trial different exercise approaches, adjusting, and adapting the exercise type, load, and context based on the individual's symptom irritability, preferences, and goals.
We contend that providing exercise therapy should remain a principal treatment option for helping individuals with RCRSP. Limitations notwithstanding, exercise therapy is relatively low cost, accessible, and often valued by individuals with RCRSP. The uncertainty surrounding exercise therapy requires ongoing research and emphasis could be directed towards investigating causal mechanisms to better understand how exercise may benefit an individual with RCRSP.
运动疗法是一种流行的非手术治疗方法，可帮助管理肩袖相关肩痛（RCRSP）患者，并且所有临床实践指南都推荐使用该方法。由于疗效的作用有限，证据质量低，疗效存在不确定性以及获益机制，运动作为一种治疗干预措施已成为越来越多的关注焦点。
本批判性评论旨在通过探索相关的定量和定性文献，阐明 RCRSP 运动治疗中存在的所谓不确定性。最后，我们提供了一些理论和实践方面的考虑，以帮助减少在临床环境中提供运动疗法的不确定性。
不确定性是为 RCRSP 患者提供运动治疗的理论和实践的基础。尽管如此，在适当的临床环境下，运动仍然是 RCRSP 患者经常选择的治疗方法。我们鼓励临床医生在进行治疗性运动处方时使用共同决策模式并采用多元化模型。这可能需要采用运动实验来尝试不同的运动方法，根据个体的症状易激惹性、偏好和目标来调整和适应运动类型、负荷和环境。
我们认为，提供运动疗法应该仍然是帮助 RCRSP 患者的主要治疗选择。尽管存在局限性，但运动疗法成本相对较低，可及性强，并且通常受到 RCRSP 患者的重视。运动疗法的不确定性需要进一步研究，重点可以放在调查因果机制上，以更好地了解运动如何使 RCRSP 患者受益。
