Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature.

OBJECTIVE To critically summarize the effectiveness of physio-therapy in patients presenting clinical signs of shoulder impingement syndrome. DESIGN Systematic review. METHODS Randomized controlled trials were searched electronically and manually from 1966 to December 2007. Study quality was independently assessed by 2 reviewers using the Physiotherapy Evidence Database (PEDro) scale. If possible, relative risks and weighted mean differences were calculated for individual studies, and relative risks or standardized mean differences for pooled data, otherwise results were summarized in a best evidence synthesis. RESULTS Sixteen studies were included, with a mean quality score of 6.8 points out of 10. Many different diagnostic criteria for shoulder impingement syndrome were applied. Physio-therapist-led exercises and surgery were equally effective treatments for shoulder impingement syndrome in the long term. Also, home-based exercises were as effective as combined physiotherapy interventions. Adding manual therapy to exercise programmes may have an additional benefit on pain at 3 weeks follow-up. Moderate evidence exists that passive treatments are not effective and cannot be justified. CONCLUSION This review shows an equal effectiveness of physiotherapist-led exercises compared with surgery in the long term and of home-based exercises compared with combined physiotherapy interventions in patients with shoulder impingement syndrome in the short and long term; passive treatments cannot be recommended for shoulder impingement syndrome. However, in general, the samples were small, and different diagnostic criteria were applied, which makes a firm conclusion difficult. More high-quality trials with longer follow-ups are recommended.