Clinical course of pain and function in subacromial shoulder pain: a systematic review with meta-analysis

Abstract

Objective: To assess the clinical course of pain and function in patients with subacromial pain. Design: Systematic review. Methods: We searched Medline, Embase, AMED, Web of Science, Cochrane Library, and Scopus for randomized clinical trials and observational studies recruiting participants with subacromial pain. Pain and function scores were extracted for groups receiving either ‘no intervention’ or ‘usual care’. Changes in pain and function from baseline were pooled at 6 weeks, 3, 6, and 12 months follow-up. Random effects meta-analyses and meta-regression were performed to assess the clinical course of pain and function in subacromial pain. Results: Nineteen studies were included and 17 studies were pooled. Data from 5 studies in the ‘no intervention’ group were pooled to 3 months, showing minimal improvement for pain (mean difference, MD, 5.3/100, 95%CI −0.8 to 11.4) and function (MD 3.1/100, 95%CI −1.7 to 7.9). Data from 12 studies in ‘usual care’ group were pooled to 12 months, showing significant improvement for pain (MD 32.5/100, 95%CI 22.6 to 42.3) and function (MD 30.3/100, 95%CI 24.4 to 36.1), with approximately 40% of this gain in the first 6 weeks. Conclusion: With ‘no intervention’, participants with subacromial pain are unlikely to show changes for pain and function within 3 months. For participants receiving ‘usual care’, recovery continued up to 12 months with almost 40% of this change during the first 6 weeks of care. Individuals with subacromial pain who received ‘usual care’ may have moderate changes in terms of minimal clinical important differences up to 12 months. PROSPERO registration number CRD42016052518.