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The Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials

  • Peter Malliaras
    Correspondence
    Corresponding authorPeter Malliaras, PhD, Physiotherapy Department, Building B, Peninsula Campus Monash University, Moorooduc Hwy, Frankston VIC 3199 Australia.
    Affiliations
    Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Peninsula Campus, Monash University, Melbourne, Victoria, Australia
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  • Renea Johnston
    Affiliations
    Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Malvern, Victoria, Australia
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  • Gabriele Street
    Affiliations
    Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Peninsula Campus, Monash University, Melbourne, Victoria, Australia
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  • Chris Littlewood
    Affiliations
    Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
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  • Kim Bennell
    Affiliations
    Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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  • Terry Haines
    Affiliations
    School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Peninsula Campus, Monash University, Melbourne, Victoria, Australia
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  • Rachelle Buchbinder
    Affiliations
    Monash Department of Clinical Epidemiology, Cabrini Institute, and Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Malvern, Victoria, Australia
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      Highlights

      • There is low-certainty evidence that higher load and volume exercise may improve function but not activity or night pain in people with rotator cuff tendinopathy compared with lower load and lower volume exercise at 6 weeks to 3 months.
      • There is very low-certainty evidence that higher load exercise does not improve function more than lower load exercise up to 6 weeks, and no data are available for pain outcomes.
      • There is very low-certainty evidence that higher volume exercise may improve function compared with lower volume exercise at 6 weeks to 3 months, but no data are available for pain outcomes.

      Abstract

      Objectives

      To compare the effectiveness and harms of higher exercise dose, including higher exercise load or higher volume, with lower exercise dose (lower load or lower volume) in individuals with rotator cuff tendinopathy.

      Design

      Systematic review.

      Data Sources

      Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL from inception to March 2019.

      Study Selection

      Randomized controlled trials comparing higher versus lower dose exercise that investigated function and pain (overall, activity, night) and adverse event outcomes were independently determined by 2 reviewers.

      Data Extraction

      Two authors independently extracted data and assessed risk of bias using the Cochrane tool. The primary endpoint was at least 6 weeks to 3 months (other endpoints included up to 6 weeks and beyond 3 months) and the Grades of Recommendation, Assessment, Development and Evaluation was used to assess evidence certainty.

      Data Synthesis

      Three trials (N=283), none at low risk of bias for all domains, were included. Low-certainty evidence (1 trial, N=102) indicated improved function (20 points [95% confidence interval, 12-28] on a 0-100 point scale) with higher load and volume exercise at 3 months, but little or no clinically important between-group difference in activity or night pain (overall pain not reported). Very low-certainty evidence (1 trial, N=120) indicated higher load exercise conferred no function benefits over lower load exercise at 6 weeks. Very low-certainty evidence (1 trial, N=61) indicated benefit of uncertain clinical importance in function with higher versus lower volume exercise at 3 months and clinically important benefit at more than 3 months (pain outcomes not reported). The risk of adverse events was uncertain.

      Conclusions

      There are few studies that have investigated higher dose exercise for rotator cuff tendinopathy. There was low to very low certainty and conflicting evidence regarding the value of higher exercise dose in individuals with rotator cuff tendinopathy.

      Keywords

      List of abbreviations:

      CI (confidence interval), RCT (randomized controlled trial), SRQ (Shoulder Rating Questionnaire)
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