Exercise for multidirectional instability of the shoulder

Multidirectional shoulder instability is characterised by symptomatic subluxation or dislocation in at least two directions, often affecting young, active individuals. Although exercise therapy is commonly recommended as a first-line treatment, its benefits and harms remain uncertain.

To assess the benefits and harms of exercise therapy in people with multidirectional instability of the shoulder.

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Clinicaltrials.gov and the World Health Organization Clinical Trials Registry Platform (ICTRP), unrestricted by date or language until May 2025.

We planned to include randomised controlled trials involving participants with traumatic or nontraumatic multidirectional instability and assessing the effects of exercise therapy compared with placebo, no treatment, waiting list, or usual care.

The critical outcomes were planned to include overall pain, shoulder disability (measured by validated self-reported scores), participant-rated global assessment of treatment success, health-related quality of life, withdrawals due to adverse events, and the occurrence of adverse events. We planned to extract data at the end of the intervention (primary time point) and at the last follow-up after the end of the intervention.

We planned to independently assess the risk of bias for each study using the RoB 2 tool.

We planned to synthesise results for each outcome within each comparison using a meta-analysis where possible. We planned to use GRADE to assess the certainty of the evidence for each outcome.

We screened 1899 records after removing duplicates. After title and abstract screening, we excluded 1882 records and assessed 17 full-text articles for eligibility. Of these, we excluded 16 articles for the following reasons: ineligible intervention (n = 13), ineligible study design (n = 2), and ineligible population (n = 1). Therefore, we did not identify any completed randomised controlled trials that met our inclusion criteria. An ongoing study that aims to compare an exercise intervention with a waiting-list control in individuals with multidirectional shoulder instability may provide evidence regarding the benefits and harms of exercise therapy in this population in the future. We contacted the investigators of the ongoing study and received a response indicating that the study had recently commenced; however, no results were yet available.

We did not find any randomised controlled trials.

As there are no published randomised controlled trials that have assessed the benefits and harms of exercise therapy in people with multidirectional instability of the shoulder, the value of this treatment is currently uncertain. Future randomised controlled trials should compare exercise therapy with a placebo, no treatment, waiting list, or usual care control, and ideally blind both participants and outcome assessment.

This Cochrane review had no dedicated funding.

Protocol (2023) DOI: 10.1002/14651858.CD015450/full.