• Goldgrub R
• Côté P
• Sutton D
• Wong JJ
• Yu H
• Randhawa K
• Varatharajan S
• Southerst D
• Mior S
• Shearer HM
• Jacobs C
• Stupar M
• Chung CL
• Abdulla S
• Balogh R
• Dogra S
• Nordin M
• Taylor-Vaisey A

• Affiliation / Centre for Disability Prevention and Rehabilitation (CDPR), Ontario Tech University and Canadian Memorial Chiropractic College (CMCC)
• Combined Modality Therapy / standards
• Open Access Document
• Outcome Assessment, Health Care
• Review Literature as Topic
• Shoulder Joint / injuries
• Soft Tissue Injuries / therapy

Objective: The purpose of this systematic review was to evaluate the effectiveness of multimodal care for the management of soft tissue injuries of the shoulder.

Methods: We conducted a systematic review and searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Two independent reviewers critically appraised studies using the Scottish Intercollegiate Guidelines Network criteria. We used best evidence synthesis to synthesize evidence from studies with low risk of bias.

Results: We screened 5885 articles, and 19 were eligible for critical appraisal. Ten randomized controlled trials had low risk of bias. For persistent subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, radial extracorporeal shock-wave therapy, or surgery. For subacromial impingement syndrome, multimodal care may be associated with small and nonclinically important improvement in pain and function compared with corticosteroid injections. For rotator cuff tendinitis, dietary-based multimodal care may be more effective than conventional multimodal care (exercise, soft tissue and manual therapy, and placebo tablets). For nonspecific shoulder pain, multimodal care may be more effective than wait list or usual care by a general practitioner, but it leads to similar outcomes as exercise or corticosteroid injections.

Conclusions: The current evidence suggests that combining multiple interventions into 1 program of care does not lead to superior outcomes for patients with subacromial impingement syndrome or nonspecific shoulder pain. One randomized controlled trial suggested that dietary-based multimodal care (dietary advice, acupuncture, and enzyme tablets) may provide better outcomes over conventional multimodal care. However, these results need to be replicated.

Note: The OPTIMa Collaboration is an initiative of the UOIT-CMCC Centre for Disability Prevention and Rehabilitation.

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.