Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis
Ana S. C. Melo, Juliana Moreira, Vera Afreixo, Daniel Moreira‐Gonçalves, Helena Donato, Eduardo B. Cruz, João Paulo Vilas‐Boas, Andreia S. P. Sousa
Abstract
BackgroundTherapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence in scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multi-joint) and ways of delivering (as dose and progression).MethodsSearch was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro, and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion and/or muscular activity. The risk of bias (ROB) was assessed through PEDro scale.ResultsFrom 8318 records identified, 8 (high to low ROB – scoring from 4 to 8 in PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises is: a) more effective than comparators in improving shoulder function (SMD=0.52 [95%Cl: 0.05,0.99], p=0.03, I2=76%); and b) as effective as comparators in reducing shoulder pain (SMD=0.32 [95%Cl: -0.09,0.73], p=0.13, I2=70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function, when the program duration was equal or higher than 6 weeks (SMD=0.43 [95%Cl: 0.09,0.76], p=0.01, I2=21%) and/or when the maximum number of exercises repetitions per session was lower than 30 (SMD=0.79 [95%Cl: 0.15,1.42], p=0.01, I2=77%). Only one study considered scapular motion as an outcome measure that revealed therapeutic exercise effectivity improving scapular range of motion.ConclusionsIntervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per session.