Identifying Conservative Interventions for Individuals with Subacromial Pain Syndrome Prior to Undergoing a Subacromial Decompression: A Scoping Review.
Joseph A Signorino, Aubrey G Thompson, Benjamin R Hando and 1 others
PMID 37020452WHAT IT FOUND
Most studies of shoulder surgery patients listed physical therapy and injections as prior care, but rarely described the exercises, dosage, or who delivered them.
Clinicians cannot judge whether conservative care was adequate because the literature omits the specifics.
Key findings
01Seventy-six percent of included studies listed physical therapy or supervised exercise as prior care, but only twenty-five percent described the specific interventions.
02In forty-three percent of studies a physical therapist was identified as the provider, while twenty-nine percent did not state who delivered the care.
03The most common cluster of prior care combined physical therapy with subacromial injections, occurring in twenty-eight percent of the studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review did not assess the quality of the included studies, so errors or biases in the original reports were not filtered out. Only English-language studies were included, which may miss relevant practices from other regions. The data relies entirely on what the original authors chose to report. If conservative care was provided but not documented in the study, it is counted as absent or unspecified. The definition of "physical therapy" varied by study, and some interventions were categorized based on whether a provider was named, which may have led to misclassification. The review covers studies from 2000 to 2022, a period during which clinical practice guidelines and surgical indications changed significantly.
Declared interests
The authors declared no conflicts of interest. The study was not funded by any commercial entity.
The easy way to misread this
Do not conclude that patients in these studies failed adequate physical therapy. The review found that most studies did not describe the exercises, dosage, or provider, so it is impossible to know if the care was appropriate or sufficient.