Studies excluded with reasons.

The primary objective of this review was to create a ‘trustworthy,’ living systematic review and meta-analysis for the application of manual therapy interventions in treating patients with shoulder dysfunction. Included studies were English-language randomized controlled trials published between 1/1/2010 and 8/3/2023, with searches performed in: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINHAL, ProQuest Nursing & Allied Health, EBSCO Medline, and PEDro. The population of focus included adults 18 years and older with musculoskeletal impairments related to shoulder dysfunction. Our primary outcomes included pain and region-specific outcome measures. We excluded trials, including participants having shoulder dysfunction resulting from surgery, radicular pain, instability/dislocation, fracture, lymphedema, and radiation. Our screening methodology was based upon a previously published ‘trustworthy’ systematic review protocol. This included the application of our PICOTS criteria in addition to screening for prospective clinical trial registration and following of prospective intent, as well as assessment of PEDro scores, risk-of-bias ratings, GRADE scoring, and examination of confidence in estimated effects. Twenty-six randomized controlled trials met our PICOTS criteria; however, only 15 of these were registered. Only three were registered prospectively. Two of these did not have discussions and conclusions that aligned with their primary outcome. The remaining single study was found to have a high risk-of-bias, meaning the remainder of the protocol could not be employed and that no randomized controlled trials could undergo further assessment or meta-analysis. The results of this systematic review indicate there are no ‘trustworthy’ randomized controlled trials examining the effectiveness of manual therapy interventions for the treatment of patients with shoulder dysfunction, as defined by the prospectively established methodology. Therefore, these findings signal that creating a ‘trustworthy,’ living systematic review on this clinically relevant topic is not yet possible due to a lack of ‘trustworthy’ randomized controlled trials.

本综述的主要目标在于构建一个‘可信赖的’动态系统综述与荟萃分析，用于评估手法治疗干预在治疗肩关节功能障碍患者中的应用。纳入的研究包括2010年1月1日至2023年8月3日期间发表的英语随机对照试验，检索范围涵盖PubMed、Cochrane中央对照试验注册库（CENTRAL）、CINHAL、ProQuest护理与辅助健康数据库、EBSCO Medline以及PEDro数据库。研究关注的对象为18岁及以上的成年人，其肌肉骨骼功能障碍与肩关节功能障碍相关。我们的主要结局指标包括疼痛及区域特异性结局指标。我们排除了因手术、根性疼痛、不稳/脱位、骨折、淋巴水肿和放射治疗引起的肩关节功能障碍的参与者。我们的筛选方法基于之前发表的‘可信赖的’系统综述方案，包括应用我们的PICOTS标准，以及对前瞻性临床试验注册和意向遵循的筛查，以及PEDro评分、偏倚风险评级、GRADE评分和估计效应的置信度评估。共有26项随机对照试验符合我们的PICOTS标准；然而，其中只有15项进行了注册。其中仅有3项为前瞻性注册。其中两项未对其主要结局进行讨论和结论，剩余的单个研究被发现存在高偏倚风险，意味着剩余的方案无法执行，且没有随机对照试验可以进一步进行评估或荟萃分析。本系统综述的结果表明，根据预先设定的方法论，尚不存在评估手法治疗干预对肩关节功能障碍患者治疗效果的‘可信赖的’随机对照试验。因此，这些发现表明，由于缺乏‘可信赖的’随机对照试验，在临床相关主题上构建‘可信赖的’动态系统综述尚不可能。