Article type
Year
Abstract
Objective: To systematically evaluate the medical literature in order to assess the efficacy of physiotherapy for shoulder pain.
Methods: A systematic computerized literature search in international bibliographic databases was conducted, supplemented with citation tracking of all relevant publications. Studies published before July 1995 were selected if physiotherapeutical interventions were randomly allocated to patients with shoulder pain. Validity of trial methods was systematically assessed by two independent reviewers.
Results: Eleven out of 20 selected trials satisfied at least 4 out of 8 validity criteria, indicating a generally low methodological quality. In most publications information is lacking about the randomisation procedure, the prognostic comparability at baseline, and the percentages of drop outs and loss to follow-up. Most studies have a small study size and blinding of patients, therapist and effect measurement is often not ensured.
Discussion: The available trials do not allow strong conclusions about the efficacy of physiotherapy for shoulder pain due to severe methodological flaws. However, among the better studies, none had results confirming the efficacy of physiotherapy, in particular ultrasound therapy. Future studies should focus on the efficacy of exercise and electrotherapy for shoulder pain. Practising physiotherapists in the Netherlands have criticized the results and conduct of the review. In their opinion the designs of the included studies do not reflect usual care, therefore, the findings cannot be translated into practice. We have subsequently designed a questionnaire that will be mailed to physiotherapists addressing the question what type of research is clinically relevant and should be given high priority. The results of this study will be presented at the conference.
Methods: A systematic computerized literature search in international bibliographic databases was conducted, supplemented with citation tracking of all relevant publications. Studies published before July 1995 were selected if physiotherapeutical interventions were randomly allocated to patients with shoulder pain. Validity of trial methods was systematically assessed by two independent reviewers.
Results: Eleven out of 20 selected trials satisfied at least 4 out of 8 validity criteria, indicating a generally low methodological quality. In most publications information is lacking about the randomisation procedure, the prognostic comparability at baseline, and the percentages of drop outs and loss to follow-up. Most studies have a small study size and blinding of patients, therapist and effect measurement is often not ensured.
Discussion: The available trials do not allow strong conclusions about the efficacy of physiotherapy for shoulder pain due to severe methodological flaws. However, among the better studies, none had results confirming the efficacy of physiotherapy, in particular ultrasound therapy. Future studies should focus on the efficacy of exercise and electrotherapy for shoulder pain. Practising physiotherapists in the Netherlands have criticized the results and conduct of the review. In their opinion the designs of the included studies do not reflect usual care, therefore, the findings cannot be translated into practice. We have subsequently designed a questionnaire that will be mailed to physiotherapists addressing the question what type of research is clinically relevant and should be given high priority. The results of this study will be presented at the conference.