Koska Daniel, Zetzsche Robert, Mayer Tobias A, Maiwald Christian
Institute of Human Movement Science and Health, Chemnitz University of Technology, 09126 Chemnitz, Germany.
Sports (Basel). 2025 Jan 14;13(1):23. doi: 10.3390/sports13010023.
Trauma-induced shoulder dislocations and sprains rank among the most common upper extremity injuries, with contact sports accounting for the majority of cases. These injuries often lead to substantial impairments in joint function and long recovery times, requiring targeted therapeutic interventions to restore mobility and prevent recurrent injuries. Given the pivotal role of exercise therapy in restoring shoulder function, this study systematically reviews the literature on the comparative effectiveness of supervised versus self-managed exercise therapy following acute shoulder trauma. PubMed, Cochrane CENTRAL, Embase, Web of Science, and Science Direct were searched up to 13 December 2024. Conservative and post-surgical treatment modes were analyzed separately. Five studies with a total 689 participants were included (conservative: = 538 across two studies; post-surgical: = 151 across three studies). Both treatment modes showed similar pooled effects (standardized mean difference, SMD: -0.35, 95% CI [-1.39, 0.69]; SMD: -0.23, 95% CI [-1.21, 0.75]), with a marginal improvement in shoulder function favoring supervised therapy. Four studies had some risk of bias, and one had serious risk; GRADE certainty was low. Supervised exercise therapy may offer slightly greater functional improvements over self-managed training, but evidence is limited by heterogeneity and low certainty. Further high-quality trials with standardized protocols and improved adherence tracking are needed to establish more definitive conclusions and guide clinical decision-making.
创伤性肩关节脱位和扭伤是最常见的上肢损伤之一，其中大多数病例发生在接触性运动中。这些损伤常常导致关节功能严重受损，恢复时间漫长，需要针对性的治疗干预来恢复活动能力并预防再次受伤。鉴于运动疗法在恢复肩部功能中发挥的关键作用，本研究系统回顾了有关急性肩部创伤后监督式运动疗法与自我管理运动疗法比较效果的文献。截至2024年12月13日，检索了PubMed、Cochrane CENTRAL、Embase、科学网和Science Direct数据库。分别分析了保守治疗和手术后治疗模式。纳入了五项研究，共有689名参与者（保守治疗：两项研究共538人；手术后治疗：三项研究共151人）。两种治疗模式显示出相似的合并效应（标准化均数差，SMD：-0.35，95%可信区间[-1.39, 0.69]；SMD：-0.23，95%可信区间[-1.21, 0.75]），监督式治疗在肩部功能方面略有改善。四项研究存在一些偏倚风险，一项研究存在严重风险；证据质量等级为低。监督式运动疗法可能比自我管理训练在功能改善方面略胜一筹，但证据受到异质性和低质量的限制。需要进一步开展具有标准化方案和改进依从性跟踪的高质量试验来得出更明确的结论并指导临床决策。
