Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis

Area of Science:

• Orthopedics
• Physical Therapy
• Evidence Synthesis

Background:

• Exercise therapy (ET) is a common initial treatment for shoulder pain.
• Evidence for ET's efficacy in speeding recovery is inconsistent.
• The benefit of combining ET with adjunct therapies for shoulder pain is unclear.

Purpose of the Study:

• To evaluate the effectiveness of ET, with or without adjunct therapies, compared to usual medical care for chronic shoulder pain.
• To synthesize direct and indirect evidence from multiple studies.
• To assess impact on pain, range of motion (ROM), and health-related quality of life (HRQL).

Main Methods:

• A network meta-analysis of randomized controlled trials was conducted.
• Searches were performed across multiple databases (MEDLINE, Embase, CINAHL, etc.).
• Frequentist hierarchical models were used for data analysis; confidence and risk of bias were assessed.

Main Results:

• Shoulder-specific ET, alone or with electro-physical agents, injections, or manual therapy, reduced pain compared to usual care.
• Manual therapy showed a meaningful improvement in ROM.
• Trends for improved ROM and HRQL were observed but not consistently significant across all adjuncts.

Conclusions:

• Shoulder-specific ET offers pain relief for chronic shoulder pain up to 52 weeks.
• Adjunct therapies provided minimal added benefit for pain reduction when combined with ET.
• The overall quality of evidence ranged from moderate to very low.