Comparing exercises with and without electromyographic biofeedback in subacromial pain syndrome: A randomized controlled trial

Which Multimodal Physiotherapy Treatment Is the Most Effective in People with Shoulder Pain? A Systematic Review and Meta-Analyses

The study aimed to determine if combined physiotherapy treatments offer additional benefits over exercise-only programs for shoulder pain and to identify the most effective combined treatment. A systematic review, registered in PROSPERO (CRD42023417709), and meta-analyses were conducted. Quality analysis was performed using the PEDro scale on randomized clinical trials published from 2018 to 2023. Twenty articles met the inclusion criteria. The most commonly used combination was exercise plus manual therapy, without being statistically superior to exercise alone. The meta-analysis indicated that combining exercise with low-level laser therapy (mean difference of -1.06, 95% CI: -1.51 to -0.60) and high-intensity laser therapy (mean difference of -0.53, 95% CI: -1.12 to 0.06) resulted in the greatest reduction in SPADI scores. Adding manual therapy provided limited additional benefit (mean difference of -0.24, 95% CI: -0.74 to 0.27). Progressive exercise with advice or telerehabilitation yielded modest improvements. The multimodal meta-analysis for DASH scores showed significant improvement (mean difference of -1.06, 95% CI: -1.51 to -0.60). In conclusion, therapeutic exercise is the cornerstone of shoulder pain treatment, with the addition of laser therapy showing substantial benefits. Manual therapy and educational interventions offer some benefits but are not consistently superior. More rigorous studies are needed.

Rotator cuff isometric exercises in combination with scapular muscle strengthening and stretching in individuals with rotator cuff tendinopathy: A multiple-subject case report

BACKGROUND AND PURPOSE

To assess the effects of a rehabilitation protocol of rotator cuff (RC) isometrics coupled with traditional shoulder exercises on patient-rated outcomes, muscle strength, and electromyographic activity in individuals with RC tendinopathy.

METHODS

Eleven individuals (8 women and 3 men, 37.9 ± 5.6 years) with RC tendinopathy performed isometric RC exercises in combination with scapular muscle stretching and strengthening for 6 weeks. Treatment effects were assessed with patient-rated pain and shoulder function, isometric muscle strength, electromyographic activity during arm elevation and internal and external shoulder rotation, and pain during arm elevation before and at the end of the first session, and after 6 weeks of intervention.

RESULTS

There were improvements in pain and shoulder function, increased isometric muscle strength for arm elevation and internal rotation, increased muscle activity of the infraspinatus and serratus anterior, and reduced pain during arm elevation after 6 weeks of intervention.

DISCUSSION

This case report showed improvements on pain and function, increases on isometric strength of the shoulder and on electromyographic activity of the serratus anterior and infraspinatus muscles, as well as decreases on pain during arm elevation, after a 6-week intervention of RC isometric exercises associated with scapular muscle stretching and strengthening in patients with RC tendinopathy.

EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: A Bayesian network meta-analysis

Background

Post-stroke shoulder-hand syndrome (SHS), although not a life-threatening condition, may be the most distressing and disabling problem for stroke survivors. Thus, it is essential to identify effective treatment strategies. Physical therapy is used as a first-line option for treating SHS; however, it is unclear which treatment option is preferred, which creates confusion in guiding clinical practice. Our study aims to guide clinical treatment by identifying the most effective physical therapy interventions for improving clinical symptoms in patients with post-stroke SHS using Bayesian network meta-analysis.

Methods

We conducted a systematic and comprehensive search of data from randomized controlled trials using physical therapy in patients with SHS from database inception to 1 July 2022. Fugl-Meyer Upper Extremity Motor Function Scale (FMA-UE) and pain visual analog score (VAS) were used as primary and secondary outcome indicators. R (version 4.1.3) and STATA (version 16.0) software were used to analyze the data.

Results

A total of 45 RCTs with 3,379 subjects were included, and the intervention efficacy of 7 physical factor therapies (PFT) combined with rehabilitation training (RT) was explored. Compared with the control group, all the PFT + RT included were of statistical benefit in improving limb motor function and pain relief. Also, our study indicated that EMG biofeedback combined with RT (BFT + RT) [the surface under the cumulative ranking curve (SUCRA) = 96.8%] might be the best choice for patients with post-stroke SHS.

Conclusion

EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with post-stroke SHS according to our Bayesian network meta-analysis results. However, the above conclusions need further analysis and validation by more high-quality RCTs.

Systematic review registration

www.crd.york.ac.uk/prospero/, identifier: CRD42022348743.