Comparative Efficacy and Patient-Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis

作者：Jie Zhang, Shuchang Zhong, Tongcai Tan, Juebao Li, Shuang Liu, Ruidong Cheng, Liang Tian, Li Zhang, Yuanjiao Wang, Fei Liu, Panpan Zhou, Xiangming Ye · 发表于：The American Journal of Sports Medicine · 年份：2020 · DOI：10.1177/0363546520956293 · 被引用次数：67 · 研究领域：Shoulder Injury and Treatment、Laser Applications in Dentistry and Medicine、Myofascial pain diagnosis and treatment

BACKGROUND: Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. PURPOSE: To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. RESULTS: Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional ...