Abstract
Background Rotator cuff–related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear.
Purpose The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physical therapy for painful rotator cuff disorders.
Data Sources The MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro databases and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) up to October 2015 were searched.
Study Selection The review included primary studies exploring prognostic models in adults undergoing physical therapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability, and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by 2 reviewers.
Data Extraction A pilot-tested form was used to extract data on key aspects of study design, characteristics, analyses, and results. Risk of bias and applicability were independently assessed by 2 reviewers using the Prediction Study Risk of Bias Assessment tool (PROBAST).
Data Synthesis Five studies were included in the review. These studies were extremely heterogeneous in many aspects of design, conduct, and analysis. The findings were analyzed narratively.
Limitations All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice.
Conclusions There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physical therapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methods.
Footnotes
All authors provided concept/idea/research design and consultation (including review of manuscript before submission). Ms Braun, Dr Hanchard, Professor Batterham, and Dr Handoll provided writing and data analysis. Ms Braun, Dr Hanchard, Dr Handoll, and Dr Betthäuser provided data collection. Ms Braun provided project management.
The authors acknowledge the assistance of Robert Wolff, Kleijnen Systematic Reviews Ltd, York, United Kingdom. Dr Wolff shared with the authors the prepublished versions of PROBAST, which they pilot tested in the development of this review, and provided support on their use. The authors also acknowledge the support from Iain Baird and Julie Hogg, Library and Information Services, Teesside University, Middlesbrough, United Kingdom, on the development of the search strategy and Hanna Björnsson Hallgren for providing unpublished analysis data.
All authors are contributors to an unfunded primary prognostic modeling study of rotator cuff disease treated by physical therapy (registration no. DRKS00004462). The systematic review also was not funded.
Systematic review registration number (PROSPERO): CRD42014008973.
- Received August 20, 2015.
- Accepted November 22, 2015.
- © 2016 American Physical Therapy Association
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