Tratamiento conservador del síndrome subacromial. Ultrasonidos frente a placebo. Un ensayo clínico

Segundo, R.M. San; Molins, Joaquim Bellmunt; Valdés, Miguel Ángel Serra; Fernández, T.R.

doi:10.1016/s0048-7120(08)73615-6

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…One trial could not be double assessed for risk of bias due to the language of publication. 33 Only 63 RCTs clearly reported how randomisation was performed. Allocation of treatments was clearly reported as adequately concealed in only 48 trials, whereas papers for 44 trials contained insufficient information to judge whether trial procedures ensured adequate concealment.…”

Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

Babatunde

Ensor

Littlewood

et al. 2021

Therapeutic Advances in Musculoskeletal

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Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others.

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Section: Resultsmentioning

confidence: 99%

Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

Babatunde

Ensor

Littlewood

et al. 2021

Therapeutic Advances in Musculoskeletal

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“…És una de les causes més freqüents de dolor Introducció musculosquelètic benigne en subjectes adults, amb un augment progressiu en relació amb l'envelliment de la població. Suposen una quarta part dels processos atesos en els serveis de rehabilitació i la causa principal són els trastorns no traumàtics de l'espatlla (Bicer i Ankarali, 2010;Green et al, 2003;Pinedo, 2006;San Segundo et al, 2008).…”

Section: Patologia De L'espatllaunclassified

“…El tractament de fisioteràpia és un pilar fonamental que en els últims anys ha cobrat especial rellevància. Els programes de rehabilitació poden incloure modalitats físiques, tècniques de potenciació, estiraments, mobilitzacions, aplicació de fred o calor, educació del pacient i reentrenament funcional (Andres i Murrell, 2008;Calis et al, 2011;Çelik et al, 2009;Ferreiro et al, 2005;Johansson et al, 2002;Michener et al, 2004;San Segundo et al, 2008;Santamato et al, 2009).…”

Section: Tractamentunclassified

“…Independentment del tractament, els objectius globals del tractament de la síndrome subacromial són alleujar el dolor, recuperar la mobilitat articular, en el cas que estigui limitada, i restaurar la funcionalitat, per tal de millorar la qualitat de vida del pacient. Es busca disminuir la inflamació dels tendons i enfortir el manegot dels rotatoris per tal de restaurar la funció de l'espatlla i eliminar el dolor (Calis et al, 2011;Çelik et al, 2009;Dickens et al, 2005;San Segundo et al, 2008).…”

Section: Tractamentunclassified

“…En un d'ells, es comparà l'ultrasò amb polsos amb tractament simulat en 73 pacients amb espatlla dolorosa, sense obtenir diferències importants entre els dos grups en els paràmetres de dolor i funcionalitat (Nykanen, 1995). En l'estudi de San Segundo no es van trobar diferències significatives en les variables dolor diürn, dolor nocturn i funcionalitat entre el grup d'ultrasò terapèutic i el grup d'ultrasò placebo; però en considerar cada grup individualment, sí que hi havia una millora d'aquestes tres variables a les tres i cinc setmanes amb referència als valors inicials en el grup d'ultrasò terapèutic, mentre que en el grup placebo només va haver-hi aquesta millora en la variable dolor nocturn (San Segundo et al, 2008). Per aquest motiu, en el nostre estudi vam utilitzar els paràmetres de l'estudi de San Segundo per aplicar l'ultrasò terapèutic i la fonoforesi.…”

Section: Evolució De La Qualitat De Vidaunclassified

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Valoració de l'eficàcia del dexketoprofèn en la síndrome subacromial amb diferents tractaments de fisioteràpia

Pérez Merino

2013

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L'ultrasò és un dels agents físics de fisioteràpia més utilitzats en el tractament de la síndrome subacromial. La fonoforesi i la iontoforesi són agents físics que, a diferència dels ultrasons, utilitzen un fàrmac com a conductor del corrent. Per valorar si l'ús del dexketoprofèn com a conductor en la fonoforesi i la iontoforesi provoca més millora clínica que l'ultrasò, es va dur a terme un assaig clínic aleatoritzat amb tres grups de tractament, sent l'agent físic diferent en cada grup. Les variables principals de l'estudi van ser l'escala visual analògica (EVA), el qüestionari DASH i l'escala de Constant-Murley.

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Electrotherapy modalities for rotator cuff disease

Page

Green

Mrocki

et al. 2016

Cochrane Database of Systematic Reviews

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Based on low quality evidence, therapeutic ultrasound may have short-term benefits over placebo in people with calcific tendinitis, and LLLT may have short-term benefits over placebo in people with rotator cuff disease. Further high quality placebo-controlled trials are needed to confirm these results. In contrast, based on low quality evidence, PEMF may not provide clinically relevant benefits over placebo, and therapeutic ultrasound, LLLT and PEMF may not provide additional benefits when combined with other physical therapy interventions. We are uncertain whether TENS is superior to placebo, and whether any electrotherapy modality provides benefits over other active interventions (e.g. glucocorticoid injection) because of the very low quality of the evidence. Practitioners should communicate the uncertainty of these effects and consider other approaches or combinations of treatment. Further trials of electrotherapy modalities for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review.

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Tratamiento conservador del síndrome subacromial. Ultrasonidos frente a placebo. Un ensayo clínico

Cited by 8 publications

References 11 publications

Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

Comparative effectiveness of treatment options for subacromial shoulder conditions: a systematic review and network meta-analysis

Valoració de l'eficàcia del dexketoprofèn en la síndrome subacromial amb diferents tractaments de fisioteràpia

Electrotherapy modalities for rotator cuff disease

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