Effectiveness of Home-Based Exercise for Nonspecific Shoulder Pain: A Systematic Review and Meta-analysis

Abstract

Objective: To evaluate the effectiveness of home-based exercise to treat nonspecific shoulder pain (NSSP).

Data sources: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Controlled Register of Trials, and Physiotherapy Evidence Database were searched from inception to January 2022.

Study selection: Independent reviewers selected randomized controlled trials that compared the effects of home-based exercise alone with no treatment or other conservative treatments in individuals with nonsurgical painful shoulder disorders. The primary outcomes were shoulder pain intensity and function, and the secondary outcome was shoulder range of motion (ROM).

Data extraction: Two reviewers independently conducted data extraction. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool, and the overall quality of the evidence was evaluated using the Grading of Recommendation Assessment, Development, and Evaluation approach.

Data synthesis: Twelve studies were included in the review, and 10 studies were included in the meta-analysis. Low to moderate quality of evidence indicated that home-based exercise alone and other conservative treatments showed equal improvements in pain intensity reduction (mean difference [MD], 0.27; 95% confidence interval [CI], -0.12 to 0.65; I²=30%), function (standardized mean difference [SMD], 0.12; 95% CI, -0.14 to 0.38; I²=16%), flexion ROM (MD, 4.61; 95% CI, -1.16 to 10.38; I²=54%), and abduction ROM (MD, 3.74; 95% CI, -12.44 to 19.93; I²=82%). Very low quality of evidence indicated that home-based exercise alone was more effective than no treatment for pain intensity reduction (MD, -1.47; 95% CI, -2.33 to -0.61) and function improvement (SMD, -0.81; 95% CI, -1.31 to -0.31; large effect).

Conclusions: Home-based exercise alone may be equally effective as other conservative treatments and superior to no treatment for the treatment of NSSP. To draw firmer conclusions, further research is required to validate these findings.

Keywords: Conservative treatment; Exercise therapy; Meta-analysis; Rehabilitation; Shoulder pain.