What do Cochrane Systematic Reviews say about conservative and surgical therapeutic interventions for treating rotator cuff disease? Synthesis of evidence

ABSTRACT BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation. Protocol registration number in the PROSPERO database: ID - CRD42018096578.

背景：运动时伴疼痛的人群中，肩痛被认为是引发肌肉骨骼功能异常的第三大病因。目的：本证据合成研究旨在明确考克兰系统评价（Cochrane Systematic Reviews）中，针对确诊肩袖疾病（rotator cuff disease）患者的保守治疗与手术治疗的临床有效性。研究设计与实施场所：本研究为系统综述的综述，由圣保罗联邦大学（Universidade Federal de São Paulo, UNIFESP）开展。方法：本证据合成研究纳入了已发表于考克兰数据库的系统综述。纳入标准为：上述系统综述的研究对象为年龄≥16岁的肩袖疾病患者，且比较了“伴或不伴非手术操作的手术方案”与“安慰剂、无治疗或其他非手术干预措施”的疗效差异。结果：本研究共纳入31篇系统综述，涉及三类对比方案：手术治疗与保守治疗的对比；伴或不伴药物辅助的干预方案与其他干预措施的对比；以及包含运动疗法、手法治疗与电热或光疗手段的干预方案对比。结论：研究结果显示，对于肩痛患者而言，无论是否联合手法治疗技术与其他辅助手段，强化运动疗法均是中长期疗效最优的干预措施，其治疗效能优于手术治疗、电疗或光生物调节治疗。PROSPERO数据库注册编号：ID - CRD42018096578。