Detailed Search Results
| Author/Association: | Johansson K, Oberg B, Adolfsson L, Foldevi M |
| Title: | A combination of systematic review and clinicians' beliefs in interventions for subacromial pain [with consumer summary] |
| Source: | British Journal of General Practice 2002 Feb;52(475):145-152 |
| Method: | systematic review |
| Method Score: | This is a systematic review. Systematic reviews are not rated. |
| Consumer Summary: | HOW THIS FITS IN: WHAT DO WE KNOW: Earlier systematic reviews of treatment of shoulder problems found no evidence of efficacy for corticosteroids and inconclusive evidence for different physiotherapy treatments. They raised the problem of heterogeneity and the lack of diagnostic criteria for different shoulder disorders, pointing at the need for a systematic review related to a more specified diagnosis, which should be easier to implement in clinical practice. WHAT DOES THIS PAPER ADD: Most common treatments for subacromial pain were trusted by both GPs and by physiotherapists. This systematic review established definitive evidence for corticosteroid injection in the subacromial bursa and tentative evidence for acupuncture. Ultrasound therapy had tentative evidence for lack of efficacy for patients with subacromial pain, questioning its use. GPs' and physiotherapists' trust in treatments had a weak association with available scientific evidence. This study helps clinicians to choose between treatments for subacromial pain and makes them aware of whether their choice is based on evidence or experience, or a combination. |
| Abstract: | The aim of the study is to determine which treatments for patients with subacromial pain are trusted by general practitioners (GPs) and physiotherapists, and to compare trusted treatments with evidence from a systematic critical review of the scientific literature. A two-step process was used: a questionnaire (written case simulation) and a systematic critical review. The questionnaire was mailed to 188 GPs and 71 physiotherapists in Sweden. The total response rate was 72% (186/259). The following treatments were trusted, ergonomics/adjustments at work, corticosteroids, non-steroidal anti-inflammatory drugs, movement exercises, acupuncture, ultrasound therapy, strengthening exercises, stretching, transcutaneous electric nerve stimulation, and superficial heat or ice therapy. The review, including efficacy studies for the treatments found to be trusted, was conducted using the CINAHL, Embase and Medline databases. Evidence for efficacy was recorded in relation to methodological quality and to diagnostic criteria that labelled participants as having subacromial pain or a non-specific shoulder disorder. Forty studies were included. The methodological quality varied and only one treatment had definitive evidence for efficacy for non-specific patients, namely injection of corticosteroids. The trust in corticosteroids, injected in the subacromial bursa, was supported by definitive evidence for short-term efficacy. Acupuncture had tentative evidence for short-term efficacy in patients with subacromial pain. Ultrasound therapy was ineffective for subacromial pain. This is supported by tentative evidence and, together with earlier reviews, this questions both the trust in the treatment and its use. The clinicians' trust in treatments had a weak association with available scientific evidence. Full text (sometimes free) may be available at these link(s):  help |
