Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis

Objective: To determine whether supervised physiotherapy is more effective for functional improvement and pain relief than a home exercise program in subjects with subacromial impingement syndrome. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised physiotherapy versus home exercise program, in the shoulder function, pain, and range of motion in subjects older than 18 years of age with a medical diagnosis of subacromial impingement syndrome treated conservatively. Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, four studies were included. The standardized mean difference for shoulder function was -0.14 points (95% CI: -1.04 to 0.76; p = 0.760), mean difference 0.21 cm (95% CI: 1.36 to 1.78; p = 0.790) for pain, and mean difference 0.62 (95% CI: -7.15 to 8.38; p = 0.880) for range of motion of flexion. Conclusion: Supervised physical therapy and home-based progressive shoulder strengthening and stretching exercises for the rotator cuff and scapular muscles are equally effective in patients with subacromial impingement syndrome treated conservatively. (C) 2019 Elsevier Ltd. All rights reserved.