Article type
Year
Abstract
Introduction: Patients with shoulder disorders are treated with a variety of interventions, including physiotherapy, steroid injections and NSAIDs. However, the controversy on the efficacy of these interventions persists.
Objective: To systematically evaluate the efficacy of common interventions for shoulder disorders.
Methods: A systematic computerized literature search in Medline and Embase was conducted, supplemented with citation tracking. Studies were selected if interventions were randomly allocated to patients with shoulder disorders. Since validity of study outcomes may depend heavily on methodological quality, the methods were assessed systematically by two blinded independent reviewers. Next, differences between intervention groups in success-rate and corresponding 95% confidence intervals were calculated for each study.
Results: 21 trials on NSAIDs, 16 on steroid injections and 20 physiotherapeutical studies were included. The quality of methods was poor; only +-19 studies were assigned a score exceeding 50% of the maximum attainable score. The studies were often flawed by lack of blinding, inadequate study size, drop-outs and loss-to-follow-up higher than 20%. The method assessment was frequently hampered by incomplete information about randomisation, prognostic comparability, compliance and co-interventions. Few papers on physiotherapy reported point estimates and corresponding distribution measures for relevant outcome measures. Statistical pooling was further obstructed by considerable heterogeneity of study populations, interventions, and outcome measures.
Discussion: The evidence in favour of the efficacy of interventions for shoulder disorders is scarce. This particularly holds for physiotherapy. Most studies that seem to be credible do not show significant differences compared with control treatment. Superior short-term efficacy of injections is demonstrated in two trials of relatively good quality. The evidence in favour of NSAIDs seems stronger, but it is unclear whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions. For the Cochrane Meeting the strength of evidence will be graded using a framework derived from the method proposed by Guyatt et al (JAMA 1995;274:1800-4).
Objective: To systematically evaluate the efficacy of common interventions for shoulder disorders.
Methods: A systematic computerized literature search in Medline and Embase was conducted, supplemented with citation tracking. Studies were selected if interventions were randomly allocated to patients with shoulder disorders. Since validity of study outcomes may depend heavily on methodological quality, the methods were assessed systematically by two blinded independent reviewers. Next, differences between intervention groups in success-rate and corresponding 95% confidence intervals were calculated for each study.
Results: 21 trials on NSAIDs, 16 on steroid injections and 20 physiotherapeutical studies were included. The quality of methods was poor; only +-19 studies were assigned a score exceeding 50% of the maximum attainable score. The studies were often flawed by lack of blinding, inadequate study size, drop-outs and loss-to-follow-up higher than 20%. The method assessment was frequently hampered by incomplete information about randomisation, prognostic comparability, compliance and co-interventions. Few papers on physiotherapy reported point estimates and corresponding distribution measures for relevant outcome measures. Statistical pooling was further obstructed by considerable heterogeneity of study populations, interventions, and outcome measures.
Discussion: The evidence in favour of the efficacy of interventions for shoulder disorders is scarce. This particularly holds for physiotherapy. Most studies that seem to be credible do not show significant differences compared with control treatment. Superior short-term efficacy of injections is demonstrated in two trials of relatively good quality. The evidence in favour of NSAIDs seems stronger, but it is unclear whether the use of NSAIDs is more favourable than analgesics, despite the higher risk of adverse reactions. For the Cochrane Meeting the strength of evidence will be graded using a framework derived from the method proposed by Guyatt et al (JAMA 1995;274:1800-4).