Background Shoulder pain due to rotator cuff tendinopathy is a common problem. Exercise is one intervention used to address this problem but conclusions from previous reviews have been mixed. Objective: To systematically review the effectiveness of exercise, incorporating loaded exercise (against gravity or resistance), for rotator cuff tendinopathy. Data sources: An electronic search of AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro and SPORTDiscus was undertaken from their inception to November 2010 and supplemented by hand searching related articles and contact with topic experts. Study eligibility criteria Randomised controlled trials evaluating the effectiveness of exercise, incorporating loaded exercise, in participants with rotator cuff tendinopathy. Study appraisal and synthesis methods Included studies were appraised for risk of bias using the tool developed by the Cochrane Back review Group. Due to heterogeneity of studies, a narrative synthesis was undertaken based upon levels of evidence. Results: Five articles detailing four studies were included, all of which were regarded as presenting a low risk of bias. Overall, the literature was supportive of the use of exercise in terms of pain and functional disability. Limitations: The results should be regarded with some degree of caution due to limitations associated with the studies including lack of blinding, no intervention control groups and limitations of the outcome measures used. Conclusion and implications of key findings:The available literature is supportive of the use of exercise but due to the paucity of research and associated limitations further study is indicated. Funding: None.

BackgroundShoulder pain is the third most common reason for consultation with a physiotherapist and up to 26% of the general population might be expected to experience an episode at any one time. Disorders of the shoulder muscles and tendons (rotator cuff) are thought to be the commonest cause of this pain. The long-term outcome is frequently poor despite treatment. This means that many patients are exposed to more invasive treatment, e.g. surgery, and/or long-term pain and disability.Patients with this disorder typically receive a course of physiotherapy which might include a range of treatments. Specifically the value of exercise against gravity or resistance (loaded exercise) in the treatment of tendon disorders is promising but appears to be under-used. Loaded exercise in other areas of the body has been favourably evaluated but further investigation is needed to evaluate the impact of these exercises in the shoulder and particularly the role of home based or supervised exercise versus usual treatment requiring clinic attendance.Methods/DesignA single-centre pragmatic unblinded parallel group randomised controlled trial will evaluate the effectiveness of a self-managed loaded exercise programme versus usual clinic based physiotherapy. A total of 210 study participants with a primary complaint of shoulder pain suggestive of a rotator cuff disorder will be recruited from NHS physiotherapy waiting lists and allocated to receive a programme of self-managed exercise or usual physiotherapy using a process of block randomisation with sealed opaque envelopes. Baseline assessment for shoulder pain, function and quality of life will be undertaken with the Shoulder Pain & Disability Index, the Patient Specific Functional Scale and the SF-36. Follow-up evaluations will be completed at 3, 6 and 12 months by postal questionnaire. Both interventions will be delivered by NHS Physiotherapist’s.An economic analysis will be conducted from an NHS and Personal Social Services perspective to evaluate cost-effectiveness and a qualitative investigation will be undertaken to develop greater understanding of the experience of undertaking or prescribing exercise as a self-managed therapy.Trial registration numberISRCTN84709751

The systematic review has become an increasingly popular method of synthesizing findings on a topic in order to inform clinical practice, commissioning of care, and future research. A central component of the systematic review is an assessment of study quality or risk of bias, i.e. an assessment of how near to the 'truth' the findings of the study are. While undertaking a recent systematic review, it became apparent that the outcomes of the quality appraisal process were somewhat different across systematic reviews where the same randomized controlled trials had been included. The quality of the report writing of the randomized controlled trials included was identified as one possible reason for this discrepancy. This had implications upon the conclusions drawn by the review. It is suggested that reasonable attempts to contact study authors should be made in order to inform the quality appraisal process while undertaking systematic reviews of randomized controlled trials and that the presence or absence of this process should be considered by research consumers when appraising the quality of a systematic review. This process enables a full assessment of study quality rather than simply an assessment of the quality of report writing.

The Hamilton Rating Scale for Depression (HRSD) has emerged as a standard in the study of depression.However, despite its extensive use and the assumption that it is a single measure, integration of data produced in studies utilizing the HRSD is difficult for several reasons. After a review of 688 relevant articles, it was determined that approximately 42% contained referencing e m r s ~~~l t i n g in confusion over which administration procedures were actually implemented. Since its introduction, several .Itemate versions of the scale

Research and learning methodologies Developing the SELF study: A focus group with patients and the public Background: Patient and public involvement (PPI) in the research process is a key feature of NHS Research and Development policy but reporting of the extent and value of PPI in relation to physiotherapy research is lacking. Aims: To determine whether the proposed methodology within the randomized controlled trial aspect of the SELF study was acceptable to patients and to ascertain whether enhancements could be made in relation to elements that matter most to patients. Methods: A focus group discussion was undertaken with four lay people who were currently attending physiotherapy. The data was transcribed verbatim and analysed using the framework method. Findings: The lay members found the proposals to be generally acceptable but were able to suggest enhancements to the SELF study's design relating to recruitment, retention, blinding, and acceptability of the intervention. Additionally, we were able to recruit lay members to the trial steering committee. Conclusion: The unique perspective offered by PPI has resulted in enhancements to the SELF study's design and a means of maintaining PPI throughout the conduct of the SELF study has been established.