The Effectiveness of Multimodal Care for the Management of Soft Tissue Injuries of the Shoulder: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

• Published in: Journal of manipulative and physiological therapeutics Vol. 39; no. 2; pp. 121 - 139.e1
• Main Authors: Goldgrub, Rachel, MHSc, Côté, Pierre, DC, PhD, Sutton, Deborah, MEd, MSc, Wong, Jessica J., DC, Yu, Hainan, MBBS, MSc, Randhawa, Kristi, MPH, Varatharajan, Sharanya, MSc, Southerst, Danielle, DC, Mior, Silvano, DC, PhD, Shearer, Heather M., DC, MSc, Jacobs, Craig, DC, MSc, Stupar, Maja, DC, PhD, Chung, Chadwick L., DC, Abdulla, Sean, MSc, DC, Balogh, Robert, BHSc (PT), MSc (Epi) PhD, Dogra, Shilpa, PhD, CSEP-CEP, Nordin, Margareta, DMedSci, Taylor-Vaisey, Anne, MLS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2016
• Subjects: Combined Modality Therapy; Glucocorticoids - therapeutic use; Humans; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Review Literature as Topic; Rotator Cuff; Shoulder Impingement Syndrome; Shoulder Injuries - therapy; Shoulder Pain; Soft Tissue Injuries; Soft Tissue Injuries - therapy; Systematic Reviews as Topic; Tendinopathy; Shoulder Impingement Syndrome; Review Literature as Topic; Rotator Cuff; Tendinopathy; Combined Modality Therapy; Shoulder Pain; Soft Tissue Injuries
• ISSN: 0161-4754; 1532-6586
• DOI: 10.1016/j.jmpt.2016.01.002

Abstract Objective The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder. Methods We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias. Results We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections. Conclusions The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.