OBJECTIVE: To evaluate the efficacy of exercise interventions with differing frequency, intensity, type, and time (FITT) on shoulder pain and disability in people with rotator cuff-related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analyses. LITERATURE SEARCH: Electronic searches were conducted up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the effects of exercise interventions differing in prescription according to the FITT principle, in people with RCRSP. DATA SYNTHESIS: Separate meta-analyses comparing exercise type (specific versus nonspecific exercise) and intensity (high versus low) were conducted. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to evaluate the certainty of evidence. RESULTS: Twenty-two RCTs (n = 1281) were included. There was moderate-certainty evidence that motor control exercise programs, when compared to nonspecific exercise programs, significantly reduced disability in the short (SMD: -0.29; 95% CI: -0.51, -0.07; n = 323; 7 RCTs) and medium terms (SMD: -0.33; 95% CI: -0.57, -0.09; n = 286; 5 RCTs), but not pain in the short term (SMD: -0.19; 95% CI: -0.41, 0.03; n = 323; 7 RCTs). Uncertainties remained regarding other exercise types (eccentric and scapula-focused exercise programs) versus nonspecific exercise programs, and exercise intensity due to low- to very low-certainty evidence. No trials were identified that compared different frequencies or times. CONCLUSION: For adults with RCRSP, motor control exercise programs were probably slightly superior to nonspecific exercise programs. However, it is unclear if the effects were due to motor control exercise or to other program characteristics such as progression and tailoring. J Orthop Sports Phys Ther 2024;54(8):499-512. Epub 7 June 2024. doi:10.2519/jospt.2024.12453.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician | |
Rehab Clinician (OT/PT) rater
This is a well-presented study that avoids overstating the findings. Importantly the comparisons only considered comparisons of control to non-specific exercises so did not consider strength or other types of exercise.
Rehab Clinician (OT/PT) rater
There is a significant lack of information about variables and parameters of exercise therapy in general, especially in patients with rotator cuff-related shoulder pain. This systematic literature review provides insight into the status quo of parameterization of exercise therapy in patients with shoulder pain but also applicable to patients with musculoskeletal pain in general.
Rehab Clinician (OT/PT) rater
This study demonstrates that some commonly held views on the rotator cuff–related shoulder pain physiotherapy program (e.g., eccentric or scapula-focused exercise programs are better, or higher load exercise programs are more effective) actually have low certainty of evidence. It also highlights many unanswered questions regarding the treatment program.
, McMaster University