ARTIGO DO MÊS (2/2009)

Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol.
Kuhn JE.

Journal of Shoulder and Elbow SurgeryVolume 18, Issue 1, January-February 2009, Pages 138-160

ABSTRACT:

A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a standard evidence-based rehabilitation protocol. Eleven randomized, controlled trials (level 1 and 2) evaluating the effect of exercise in the treatment of impingement were identified. Data regarding demographics, methodology, and outcomes of pain, range of motion, strength, and function were recorded. Individual components of each rehabilitation program were catalogued. Effectiveness was determined by statistical and clinical significance. Although many articles had methodologic concerns, the data demonstrate that exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. Manual therapy augments the effects of exercise, yet supervised exercise was not different than home exercise programs. Information regarding specific components of the exercise programs was synthesized into a gold standard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement.

Conclusion
this systematic review of the best available evidence for exercise in the treatment of impingement syndrome was able to generate a physical therapy protocol that has been shown to be effective in level 1 and level 2 studies. This evidence-based protocol can be used by clinicians treating impingement syndrome and can serve as a gold standard to reduce variables in future cohort and comparative studies to help find better treatments for patients with this disorder.

Implicações clinicas
Baseado nesta revisão sistemática o autor propõe um protocolo de exercícios - "Evidence-based medicine exercise protocol for impingement syndrome" - que deve ser considerado não como uma receita universal mas com uma matriz com linhas de orientação terapêutica.

Raul Oliveira, Fisioterapeuta
R´Equilibri_us - Gabinete de Fisioterapia
Av. D. João I, nº 8, Oeiras
309 984 508 / 917231718
raulov@netcabo.pt
Faculdade de Motricidade Humana