A systematic review 1 including 12 studies of moderate quality with a total of 599 subjects was abstracted in DARE. Six trials demonstrated a benefit from therapeutic exercise programmes. Benefits in terms of shoulder function, pain and disability were observed when exercise was compared with placebo or no intervention. Benefits in comparison with surgery were unclear. The design of an optimal exercise programme, in terms of techniques, frequency, intensity and level of supervision, was unclear. Two trials suggested that joint mobilisation combined with therapeutic exercise might lead to better outcomes. However, it was unclear which patients are most likely to respond to this combination and the exact techniques to be used were also unclear.
Conflicting evidence from 3 trials suggested that low-level laser therapy is more beneficial than placebo when applied as a single intervention. However, no additional benefits on the outcomes of pain and improvement of function were demonstrated when laser therapy was added to exercise. Ultrasound did not appear to be beneficial and the evidence for acupuncture was equivocal.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).
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