Shoulder rotator cuff disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations

Patrick Doiron-Cadrin, Simon Lafrance, Marie Saulnier, Émie Cournoyer, Jean-Sébastien Roy, Joseph-Omer Dyer, Pierre Frémont, Clermont Dionne, Joy C MacDermid, Michel Tousignant, Annie Rochette, Véronique Lowry, Nathalie J Bureau, Martin Lamontagne, Marie-France Coutu Psy, Patrick Lavigne, François Desmeules
Archives of Physical Medicine and Rehabilitation 2020 January 30

OBJECTIVES: To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults.

DATA SOURCES: A systematic bibliographic search was conducted up until May 2018 in Medline, Embase and PeDro databases, in addition to twelve clinical guidelines search engines listed on the AGREE Thrust website.

STUDY SELECTION: Nine CPGs on the management of rotator cuff disorders in adults and/or workers, available in English or French and published from January 2008 onward, were included and screened by two independent reviewers.

DATA EXTRACTION: CPGs methodology was assessed with the AGREE II tool. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following four levels: "Essential", "Recommended", "May be recommended" and "Not recommended".

DATA SYNTHESIS: Methodological quality was considered high for three CPGs and low for six. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen and/or NSAIDs prescription and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return to work strategies included intervening early, use of a multidisciplinary approach and adaptation of work organization.

CONCLUSIONS: Only three CPGs were of high quality. The development of more rigorous CPGs is warranted.


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