Review ArticleThe effect of exercise-based management for multidirectional instability of the glenohumeral joint: a systematic review
Section snippets
Methods
The authors of this article, before conducting a literature search, developed a review protocol that is summarized herein.
Search results
After omission of duplicate citations, the search yield was 6,619. After omission of citations that were clearly irrelevant, 114 full-text articles were identified for full-text retrieval. Of these, a total of 7 articles met the inclusion criteria for the review. The number of results received at each stage of the review process, along with the number of studies excluded and reasons for exclusion, is outlined in Figure 1.
Characteristics of included studies
Table II displays the characteristics of the included studies. Study
Discussion
For before-and-after comparisons of exercise-based management for MDI, this review showed very low-quality evidence for improvements in shoulder kinematics, The Rowe score, overall status rating, and peak muscle strength. The very low grade of evidence means that any estimate of effect is very uncertain.45
For most of the remaining outcomes, lack of data or only post-intervention comparisons with a surgery group meant that the effects of exercise alone over time were almost impossible to
Conclusion
This review showed that there is large heterogeneity among studies of very poor quality for the effects of exercise for MDI. Exercise appears beneficial for patients with nontraumatic MDI; however, its true effects are difficult to evaluate because of literature fraught with high levels of bias. Exercise protocols are poorly defined in the literature, making evaluation of their true effects challenging. There is a fundamental need for high-quality intervention studies to be undertaken to
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References (52)
- et al.
Multidirectional instability of the glenohumeral joint
Orthop Clin North Am
(2000) - et al.
Multidirectional instability: evaluation and treatment options
Clin Sports Med
(2008) - et al.
GRADE guidelines: 3. Rating the quality of evidence
J Clin Epidemiol
(2011) - et al.
Multidirectional instability of the shoulder in the female athlete
Clin Sports Med
(2000) - et al.
Glenohumeral instability and dislocation
Phys Med Rehabil Clin N Am
(2004) - et al.
GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables
J Clin Epidemiol
(2011) - et al.
GRADE guidelines 6. Rating the quality of evidence—imprecision
J Clin Epidemiol
(2011) - et al.
GRADE guidelines: 8. Rating the quality of evidence—indirectness
J Clin Epidemiol
(2011) - et al.
GRADE guidelines: 7. Rating the quality of evidence—inconsistency
J Clin Epidemiol
(2011) - et al.
GRADE guidelines 12. Preparing summary of findings tables-binary outcomes
J Clin Epidemiol
(2013)
GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology
J Clin Epidemiol
GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)
J Clin Epidemiol
How to estimate treatment effects from reports of clinical trials. II: Dichotomous outcomes
Aust J Physiother
Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program
J Shoulder Elbow Surg
Electromyographic analysis during pull, forward punch, elevation and overhead throw after conservative treatment or capsular shift at patient with multidirectional shoulder joint instability
J Electromyogr Kinesiol
Scapular inclination and glenohumeral joint stability: a cadaveric study
J Orthop Sci
Physiotherapy vs. capsular shift and physiotherapy in multidirectional shoulder joint instability
J Electromyogr Kinesiol
(ii) The classification of shoulder instability: new light through old windows!
Curr Orthop
Multidirectional instability: current concepts
J Shoulder Elbow Surg
A longitudinal study of patients with multidirectional instability of the shoulder with seven- to ten-year follow-up
J Shoulder Elbow Surg
Shoulder electromyography in multidirectional instability
J Shoulder Elbow Surg
Analysis of evidence-based medicine for shoulder instability
Arthroscopy
HIV and male circumcision—a systematic review with assessment of the quality of studies
Lancet Infect Dis
An assessment of the interexaminer reliability of tests for shoulder instability
J Shoulder Elbow Surg
Management of multidirectional instability
Clin Sports Med
Arthroscopic treatment of multidirectional shoulder instability in athletes: a retrospective analysis of 2- to 5-year clinical outcomes
Am J Sports Med
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No ethics committee approval was required to conduct and produce this systematic review.