SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS OF INTERVENTIONS FOR PAINFUL SHOULDER - SELECTION CRITERIA, OUTCOME ASSESSMENT, AND EFFICACY

Objective: To review the efficacy of common interventions for shoulder pain. Design: All randomised controlled trials of non-steroidal anti- inflammatory drugs, intra-articular and subacromial glucocorticosteroi d injection, oral glucocorticosteroid treatment, physiotherapy, manipu lation under anaesthesia, hydrodilatation, and surgery for shoulder pa in that were identified by computerised and hand searches of the liter ature and had a blinded assessment of outcome were included. Main outc ome measures: Methodological quality (score out of 40), selection crit eria, and outcome measures. Effect sizes were calculated and combined in a pooled analysis if study population, end point and intervention w ere comparable.Results: Thirty one trials met inclusion criteria. Mean methodological quality score was 16.8 (9.5-22). Selection criteria va ried widely, even for the same diagnostic label. There was no uniformi ty in the outcome measures used, and their measurement properties were rarely reported. Effect sizes for individual trials were small(range -1.4 to 3.0). The results of only three studies investigating ''rotato r cuff tendinitis'' could be pooled. The only positive finding was tha t subacromial steroid injection is better than placebo in improving th e range of abduction (weighted difference between means 35 degrees (95 % confidence interval 14 to 55)). Conclusions: There is little evidenc e to support or refute the efficacy of common interventions for should er pain. As well as the need for further well designed clinical trials , more research is needed to establish a uniform method of defining sh oulder disorders and developing outcome measures which are valid, reli able, and responsive in affected people.