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Noninvasive management of soft tissue disorders of the shoulder: A clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

European journal of pain (London, England)
September 1, 2021
Hainan Yu et al. (25 authors)
Journal ArticleResearch Support, Non-U.S. Gov'tReviewHuman Study
Study Details

Study Goal

The researchers aimed to develop evidence-based guidelines for noninvasive management of shoulder pain, including evaluating the effectiveness of Low-Level Laser Therapy.

Results Summary

The study found that Low-Level Laser Therapy is effective for treating shoulder pain of any duration, alongside other multimodal care approaches. It was recommended as a viable treatment option in the guideline.

Population

Adults with shoulder pain, excluding major pathology.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (15)
InterventionDirectionEndpointPopulationDosageImpactClaim #
low-level laser therapy
decrease
shoulder pain of any duration
adults with shoulder pain
-
can be effectively treated
#1
multimodal care (heat/cold, joint mobilization, and range of motion exercise)
decrease
shoulder pain of any duration
adults with shoulder pain
-
can be effectively treated
#2
cervicothoracic spine manipulation and mobilization
decrease
shoulder pain of any duration
adults with shoulder pain
-
can be effectively treated
#3
thoracic spine manipulation
decrease
shoulder pain of any duration
adults with shoulder pain
-
can be effectively treated
#4
stretching and/or strengthening exercises
decrease
shoulder pain >3-month duration
adults with shoulder pain
-
can be effectively treated
#5
laser acupuncture
decrease
shoulder pain >3-month duration
adults with shoulder pain
-
can be effectively treated
#6
general physician care (information, advice, and pharmacological pain management if necessary)
decrease
shoulder pain >3-month duration
adults with shoulder pain
-
can be effectively treated
#7
shock-wave therapy
decrease
shoulder pain with calcific tendinitis on imaging
adults with shoulder pain
-
can be effectively treated
#8
ultrasound
no change
shoulder pain of any duration
adults with shoulder pain
-
do not offer
#9
taping
no change
shoulder pain of any duration
adults with shoulder pain
-
do not offer
#10
interferential current therapy
no change
shoulder pain of any duration
adults with shoulder pain
-
do not offer
#11
diacutaneous fibrolysis
no change
shoulder pain of any duration
adults with shoulder pain
-
do not offer
#12
soft tissue massage
no change
shoulder pain of any duration
adults with shoulder pain
-
do not offer
#13
cervicothoracic spine manipulation and mobilization as an adjunct to exercise
no change
pain between the neck and the elbow at rest or during movement of the arm
adults with shoulder pain
-
do not offer
#14
shock-wave therapy
no change
shoulder pain >3-month duration
adults with shoulder pain
-
do not offer
#15
Abstract

OBJECTIVES: Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. METHODS: This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. RESULTS: When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. CONCLUSIONS: Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. SIGNIFICANCE: Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).

Medical Subject Headings (MeSH)
AdultExercise TherapyHumansOntarioRange of Motion, ArticularShoulderShoulder Pain
Study Links
Quality Scores
SafetyNot Assessed
Efficacy80/10
Quality90/10
Citation Metrics
Total Citations8
Citations/Year2.0
Relative Citation Ratio1.39
NIH Percentile62.3%
Research Impact Scores
APT Score0.25
Weight Score2.62
Normalized Score0.70
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