The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis.

Authors: Hanratty CE (1) , McVeight JG (1) , Kerr DP (1) , Basford JR (2) , Finch MB (3) , Pendleton A (3) , Sim J (4)
(1) School of Health Sciences, Health and Rehabilitation Sciences Research Institute, University of Ulster (2) Mayo Clinic, Rochester (3) Rheumatology Department, Musgrave Park Hospital, Belfast Health and Social Care Trust (4) Arthritis Research UK Primary Care Centre, Keele University
Source: Semin Arthritis Rheum. 2012 Dec;42(3):297-316.
DOI: 10.1016/j.semarthrit.2012.03.015 Publication date: 2012 Dec E-Publication date: May 18, 2012 Availability: abstract Copyright: © 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
Language: English Countries: Not specified Location: Not specified Correspondence address: McVeigh JG :


Article abstract


To evaluate the effectiveness of exercise in the treatment of people with subacromial impingement syndrome (SAIS).


A systematic review and meta-analysis were conducted. Ten electronic databases were searched from the dates of their inception until August 2010. Included studies were randomized controlled trials investigating exercise in the management of SAIS. Outcomes were pain, strength, function, and quality of life. Data were summarized qualitatively using a best evidence synthesis. Treatment effect size and variance of individual studies were used to give an overall summary effect and data were converted to standardized mean difference with 95% confidence intervals (standardized mean difference (SMD) (CI)).


Sixteen studies were included (n = 1162). There was strong evidence that exercise decreases pain and improves function at short-term follow-up. There was also moderate evidence that exercise results in short-term improvement in mental well-being and a long-term improvement in function for those with SAIS. The most common risk of bias across the studies was inadequately concealed treatment allocation. Six studies in the review were suitable for meta-analysis. Exercise had a small positive effect on strength of the rotator cuff in the short term (SMD -0.46 (-0.76, 0.16); P = 0.003) and a small positive effect on long-term function (SMD -0.31 (-0.57, 0.04); P = 0.02).


Physiotherapy exercises are effective in the management of SAIS. However, heterogeneity of the exercise interventions, coupled with poor reporting of exercise protocols, prevented conclusions being drawn about which specific components of the exercise protocols (ie, type, intensity, frequency and duration) are associated with best outcomes.

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