A systematic review of interventions for shoulder pain

Article type
Authors
Buchbinder R, Glazier R, Green S
Abstract
Introduction: Shoulder pain is a common condition with significant morbidity. Many forms of therapy have been advocated, but evidence of their efficacy is not well documented.

Objective: To perform a series of seven separate reviews of randomised controlled trials for shoulder pain, assessing:

* non steroidal anti-inflammatory medication
* physiotherapy
* intra-articular and subacromial steroid injection
* hydrodilatation (shoulder distension)
* manipulation under anaesthesia (MUA)
* oral steroid medication
* surgery (arthroscopic and open)

The major outcomes of interest were relief of pain and improvement of motion.

Methods: The search strategy sought to identify all relevant trials. Computer Based Searches: MEDLINE, EMBASE, CINAHL and Science Citation Index (SCISEARCH) searches back to 1966. Hand Searches of major textbooks, bibliographies of relevant literature, the fugitive literature, and the subject indices of relevant journals back to 1966. Each identified study was assessed for possible inclusion by two independent reviewers based on the blinded methods sections. The major determinant for inclusion was that the study be a randomised controlled trial and that the outcome assessment be blinded. The same reviewers then assessed the methodological quality of the included studies based upon assessment of the blinded methods and the blinded results. This weighted the analysis. Data was extracted, facilitated by the Cochrane software, REVMAN.

Results: 58 trials have been identified and, while results are yet to be finalised, to date few demonstrate high methodological ranking. Final results will be available for presentation at the 4th International Cochrane Colloquium.