What is the evidence for therapeutic exercise in the treatment of rotator cuff pathology?
AMSTAR Rating
Summary
Patient Population:
All patients participating in studies were symptomatic. Reported age ranged from a mean of 47.6 to 55.6 (though age was not always reported). Sample composition ranged from 77% female to 100% male. The type of information reported regarding patient samples varied widely and basic patient descriptors appear inconsistently reported.
Intervention:
Supervised exercise or home exercise programs. Supervised exercise: defined as exercise undertaken with regular contact over the duration of the intervention. Home exercise: defined as a program of exercise undertaken without regular contact with a healthcare professional. The content of the programs tended to include stretching and progressive resistance exercises using equipment such as Therabands, but overall, programs were general heterogeneous. Duration of treatment varied, but appear to be 8-12 weeks.
Comparison:
Comparison conditions varied and included the following: no intervention, placebo, surgery, functional brace, multimodal physiotherapy. 5 articles, describing 4 studies were included in the review.
Outcome:
- Pain: supervised exercise vs. placebo (1 RCT) – reduction in pain over short-term.
- Function: supervised exercise vs. placebo (1 RCT) – improvement in function over short-term.
- Pain: supervised exercise vs. surgery (1 CT) – no significant difference over short, medium or long term.
- Function: supervised exercise vs. surgery (1 CT) – no significant difference over short, medium or long term.
- Pain: home exercise vs. no intervention (1 RCT) – reduction in pain over short-term.
- Function: home exercise vs. no intervention (1 RCT) – improvement in function over the short-term.
- Function: home exercise vs. functional brace (1 RCT) – no significant difference.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS 2010 - full thickness tear | Inconclusive |
| AAOS 2010 - in the absence of full thickness tear | Moderate |
| AOTA 2009 | Level C |
| ACOEM 2011 | Level C |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Supervised Exercise vs. Placebo
Pain
Function
Supervised Exercise vs. Surgery
Pain
Function
Home Exercise vs. No Intervention
Pain
Function
Home Exercise vs. Functional Brace
Function
