Supervised training compared with no training or self-training in patients with subacromial pain syndrome: a systematic review and meta-analysis.

Abstract

OBJECTIVE\nTo study the effects of supervised training in adults with subacromial pain syndrome.\n\n\nDATA SOURCES\nEMBASE, MEDLINE, Cochrane Library, Cinahl, and Pedro were searched from inception to March 2020.\n\n\nSTUDY SELECTION\nIndependent reviewers selected randomised controlled trials comparing supervised training with a) no training or b) self-training in adults with subacromial pain syndrome lasting for at least one month. Critical outcomes were shoulder pain, function, and patient-perceived effect. Important outcomes included other potential benefits and adverse events at three-month follow up.\n\n\nDATA EXTRACTION\nTwo independent reviewers extracted data for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool 1, and certainty of evidence was evaluated using GRADE.\n\n\nDATA SYNTHESIS\nTen studies (n=597, 43% females) were included. Supervised training resulted in larger improvements than no training on pain (at rest: n=286; mean difference (MD) 1.68, 95% Confidence Interval (CI) 0.31, 3.06 on 0-10 scale; during movement: n\u202f=\u202f353; MD 1.84, 95% CI 0.91, 2.76), function (n=396; standardized MD 0.30, 95% CI 0.07, 0.52), and patient-perceived effect (n=118; risk ratio 1.43, 95% CI 0.87, 2.34). Supervised training had potential benefits regarding quality of life, return to work, dropout, and training adherence, albeit more patients reported mild, transient pain following training. Supervised training and self-training showed equal improvements on pain (n\u202f=\u202f44) and function (n\u202f=\u202f76), with no data describing patient-perceived effect. Certainty of evidence was low for critical outcomes, and low-moderate for other outcomes.\n\n\nCONCLUSION\nSupervised training might be superior to no training and equally effective as self-training on critical and important outcomes. Based on low-moderate certainty of evidence, these findings support a weak recommendation for supervised training in adults with subacromial pain syndrome.