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Ajot09184_vonderheyde 16.23

Occupational Therapy Interventions for ShoulderConditions: A Systematic Review The objectives of this systematic review were (1) to identify, evaluate, and synthesize the research literature of relevance to occupational therapy regarding interventions for work-related shoulder conditions and (2) tointerpret and apply the research literature to occupational therapy. Twenty-two studies were reviewed for this study—16 of Level I evidence, 2 of Level II evidence, and 4 of Level III evidence. In this systematic review, limited evidence from Level I studies was found to support exercise for shoulder pain; manual therapy and laser for adhesive capsulitis; conservative management of shoulder instability; early intervention without immobilization for specific, nondisplaced proximal humerus fractures; and exercise, joint mobilizations, and laser for patients with shoulder impingement. Further prospective studies are necessary for the delineationof specific surgical and therapeutic variables that facilitate positive outcomes in the treatment of patientswith shoulder conditions.
von der Heyde, R. L. (2011). Occupational therapy interventions for shoulder conditions: A systematic review. American Journal of Occupational Therapy, 65, 16–23. doi: 10.5014/ajot.2011.09184 Rebecca L. von der Heyde, PhD, OTR/L, CHT, is Associate Professor of Occupational Therapy, OccupationalTherapy Program, Maryville University, 650 Maryville What occupational therapy interventions are effective in the rehabilitation of people with work-related injuries or clinical conditions of the shoulder? Objectives of the Evidence-Based Literature Review The objectives of this literature review were (1) to identify, evaluate, and synthesizethe research literature of relevance to occupational therapy regarding interven-tions for work-related shoulder conditions of relevance to occupational therapyand (2) to interpret and apply the research literature to occupational therapy.
The shoulder complex is an intricate arrangement of bones, joints, nerves, andmuscles that facilitate functional range of motion (ROM) of the upper extremity.
The shoulder complex comprises four separate articulations, including theglenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular joints.
The shoulder complex sacrifices inherent joint stability to allow maximal levels ofmobility, thereby optimizing the position of the elbow, wrist, forearm, and handfor activities of daily living (ADLs), instrumental activities of daily living(IADLs), work, education, and leisure. Dynamic stability is afforded to theshoulder complex through the rotator cuff musculature—a group of four muscleslocated in tight approximation to the glenohumeral joint. The positioning ofthese muscles as it relates to several bony prominences, including the narrowsubacromial space, increases the risk for impingement-related syndromes(Oatis, 2009).
Patients with chronic, subacute, acute, and postoperative shoulder diagnoses are commonly referred to occupational therapists working in inpatient, January/February 2011, Volume 65, Number 1 outpatient, home health, and industrial practice areas.
between 6 and 12 wk, as subacute; and for >3 mo, These diagnoses include pain, rotator cuff tears, frozen as chronic. In a study by Reilingh, Kuijpers, Tanja- shoulder (also termed adhesive capsulitis), shoulder in- Harfterkamp, and van der Windt (2008), patients with stability, anterior dislocation, proximal humerus frac- acute pain achieved the most positive outcomes in terms of pain and disability after 6 mo, whereas patients with chronic pain had the least favorable outcomes. Higher Occupational therapists use various types of inter- baseline pain, lower pain catastrophizing, and lower ventions to treat conditions of the shoulder complex.
baseline disability predicted positive outcomes for pa- Interventions range from preparatory activities, such as tients in the study (Reilingh et al., 2008).
modalities and ROM, to occupation-based interventions Longitudinal studies have also been pursued in an focusing on client-centered roles and goals. Interventions attempt to identify predictive variables. In a study by are implemented both in a preventive fashion and in Siivola et al. (2004), pain and dynamic sports loading response to acute, subacute, chronic, and postoperative during adolescence were associated with pain in early symptomatology. An occupation-based and client- adulthood. Psychosomatic stress symptoms were predic- centered approach to evaluation and treatment, as tive of pain within 7 yr (Siivola et al., 2004). Psycho- afforded by an occupational therapist, offers the patient an logical factors, including increased worry and decreased opportunity to return to valued daily life activities and vitality, were also found to be associated with poor out- occupations. These approaches will benefit substantially comes in a study by Bot et al. (2005), who noted that from the use of evidence to support their effectiveness. The duration and previous history of symptoms negatively incorporation of evidence-based practice will not only affected outcomes in patients with neck or shoulder strengthen the profession but also contribute to its lon- Occupational therapists have the opportunity to The purpose of this systematic review, therefore, was influence the outcomes of patients with shoulder to investigate the effectiveness of interventions used by MSDs. Holistic interventions attending to all aspects of occupational therapists in the rehabilitation of people reported symptomatology, including pain, function, and with work-related injuries and clinical conditions of the psychological factors, can contribute to clients’ health- related quality of life. The importance of evidence tosupport such interventions, however, cannot be un- derstated. This systematic review is intended to con-tribute to the pursuit of evidence-based practice for Musculoskeletal disorders (MSDs) of the shoulder have patients with shoulder conditions in the practice of been studied extensively as they relate to factors in the workplace. According to the U.S. Bureau of Labor Sta-tistics (2008), in 2007 75,580 shoulder injuries ac- counted for 6.5% of nonfatal occupational injuries and illnesses involving days away from work. After a system-atic review of epidemiological evidence, the National This systematic review was completed in conjunction Institute for Occupational Safety and Health (NIOSH; with the American Occupational Therapy Association’s 1997) suggested factors that contribute to shoulder (AOTA’s) Evidence-Based Literature Review Project. As MSDs, including repetition and assumption of postures one component of Occupational Therapy and Clinical surpassing 60° of flexion or abduction. The risk for Conditions Related to Worker’s Compensation, the specific shoulder MSDs is proposed to increase with combined methodology used to complete this review can be found exposure to multiple risk factors, such as working with in “Methodology for the Systematic Reviews on Occu- a tool in an overhead position (NIOSH, 1997). This pational Therapy for People With Work-Related Injuries review did not find evidence to link force or vibration to and Illnesses” (Arbesman, Lieberman, & Thomas, 2011) Shoulder pain has also been suggested to affect be- Search strategies and terms specific to this review tween 7% and 34% of the adult population (Luime et al., focused on work-related injuries and clinical conditions of 2004) and is often the primary symptom of patients with the shoulder. Using the workers’ compensation compi- shoulder MSDs. On presentation to a physician, pain lation of diagnoses, the following terms were searched: symptoms noted for <6 wk are categorized as acute; thoracic outlet syndrome, DJD (degenerative joint disease), The American Journal of Occupational Therapy adhesive capsulitis, rotator cuff syndrome, shoulder tendon- trol. A comparison of exercise groups with the control itis, bicipital tendonitis, subacromial bursitis, shoulder im- group showed significant reductions in visual analog scale pingement, rotator cuff tear, calcific shoulder, shoulder pain at present and at worst in the exercise groups, offering impingement, fracture anatomical neck humerus, fracture limited evidence to support the efficacy of exercise pro- greater tuberosity humerus, fracture humerus shaft, sprains grams to reduce pain in work-related trapezius myalgia.
and strains rotator cuff, rotator cuff tear, shoulder strain, Geraets et al. (2005) compared graded exercise ther- crushing injury upper arm, complex regional pain syndrome, apy with usual care, including information, recommen- and reflex sympathetic dystrophy. Other terms included dations, and pain control on an as-needed basis. The shoulder, shoulder pain, shoulder joint, axilla, glenohumeral authors described graded exercise therapy as a behavioral joint, and scapulothoracic articulation. Searches for in- program based on graded activity, time contingency, and terventions and treatments and for outcome measures operant conditioning. A Level I RCT was completed with and assessments were similar to those used for the back, 176 patients. Graded exercise therapy was shown to have a minimally greater benefit than usual care for patients Twenty-two studies were reviewed for this study: 16 studies at Level I, 2 studies at Level II, and 4 studies at Using a more specific approach, Lundblad, Elert, and Level III. Supplemental Table 1 summarizes the studies Gerdle (1999) compared Feldenkrais interventions with included in the review and is available online at typical therapeutic interventions for patients with com- (navigate to this article, and click on “sup- plaints of the neck and shoulder. With a sample of 97 plemental materials”). The table was created through patients, this Level I RCT supported Feldenkrais therapy a comprehensive analysis of study objectives, level, and as a holistic preparatory intervention that facilitates re- design; the interventions and outcome measures used; and the study results, limitations, and implications for In 2005, Sjo¨gren et al. studied workplace intervention occupational therapy practice. The results of the sys- on headaches, neck and shoulder symptoms, and upper- tematic review are presented in the sections that follow.
extremity strength in a sample of 53 office workers. Usinga Level II cluster RCT, they compared exercise and re-sistance intervention with a no-physical-exercise inter- vention. The study offered limited evidence that daily light resistance training guided by a therapist can decreasehead and neck symptoms and increase shoulder extension Multiple studies have addressed the use of various forms of strength for patients who perform physically light work.
exercise as interventions for neck pain and shoulder pain.
In addition to exercise, biopsychosocial rehabilitation Four Level I randomized control trials (RCTs) and one programs and laser have both been researched as inter- Level II cluster RCT were reviewed with regard to exercise, ventions that might influence shoulder pain. A systematic whereas one Level I systematic review addressed bio- review by Karjalainen et al. (2005) was completed with psychosocial rehabilitation and one Level I RCT con- the intent of establishing the effectiveness of multi- disciplinary biopsychosocial rehabilitation for adults Randløv et al. (1998) studied the effectiveness of two with neck and shoulder pain. Only two studies were types of training on patients with chronic neck and found that met the search criteria, offering little scientific shoulder pain. This Level I RCT included a sample of 77 evidence to support multidisciplinary biopsychosocial re- women with chronic pain lasting >6 mo. Patients were habilitation programs as beneficial for working-age adults randomized into either the intensive training or the lighter program, and both programs were shown to be beneficial Bingo¨l, Altan, and Yurtkuran (2005) studied the use in improving function for patients with chronic neck and of laser treatment for shoulder pain in a Level I double- shoulder pain. The success rate in the study was 50% at the blind RCT. Their sample of 40 was randomized into conclusion of treatment and 60% at the 12-mo follow-up.
either an active laser treatment group or a placebo laser Waling, Sundelin, Ahlgren, and Ja¨rvholm (2000) treatment group. Both groups exercised after treatment.
investigated the effectiveness of strength, endurance, and The use of low-energy laser therapy treatment was not coordination programs on neck and shoulder pain in demonstrated as being significantly more efficacious than women with work-related trapezius myalgia. This Level I RCT included 126 women placed in one of four groups: The four Level I RCTs and one Level II cluster RCT (1) strength, (2) endurance, (3) coordination, or (4) con- reviewed here offer limited evidence to support the use January/February 2011, Volume 65, Number 1 of exercise as an occupational therapy intervention for Manual Therapy. Joint mobilization and manipulation, shoulder pain, including light and intensive training, interventions based in proper knowledge of arthrokine- graded exercise therapy, strength and endurance training, matics, have been studied for use in patients with frozen and Feldenkrais therapy. Future studies with larger sample shoulder. Whereas joint mobilizations are slow, con- sizes and diversity will contribute to a greater under- trolled, passive motions aimed at facilitating typical joint standing of how exercise can affect neck and shoulder pain.
glide, joint mobilizations are a more aggressive technique Sufficient evidence to support biopsychosocial rehabili- performed at the end ranges of joint motion.
tation programs and the use of laser therapy for shoulder Guler-Uysal and Kozanoglu (2004) studied the early response of rehabilitation for adhesive capsulitis with atten-tion to clinical efficacy and cost-effectiveness. Their Level I randomized, comparative prospective clinical trial included Many articles have addressed intervention after rotator a sample of 40 patients in two groups: a Cyriax group and cuff injuries. Three recent Level I systematic reviews have a therapy group. The Cyriax method of rehabilitation, which attended to the results of said research. Grant, Arthur, and includes deep friction massage and joint manipulation, was Pichora (2004) completed a Level I systematic review of shown to produce significantly greater changes in gleno- 64 articles to analyze the effectiveness of surgical and humeral flexion, rotations, and pain in a significantly de- conservative treatments for rotator cuff pathologies. The creased amount of treatment time compared with standard authors concluded that current research on rotator cuff physical therapy using superficial and deep heat treatments.
pathology does not strongly support or refute any avail- Vermeulen, Rozing, Obermann, le Cessie, and Vliet able intervention for this condition. The evidence to Vleland (2006) considered the effectiveness of high-grade support the conservative techniques of electrotherapy, versus low-grade mobilization techniques for patients steroid injections, exercise therapy, and acupuncture was with adhesive capsulitis of the shoulder. This Level I weak. Ejnisman et al. (2005) reviewed the efficacy and RCT included 100 participants in either a high-grade or safety of common interventions for tears of the rotator low-grade mobilization group. Both groups were noted cuff in a systematic review of eight studies. These re- to improve significantly over 12 mo; however, the high- searchers similarly concluded that little evidence supports grade group was also noted to have a significant change in or refutes conservative or surgical management of rotator subjective ratings of pain and disability. These results provide limited evidence to support the efficacy of high- Green, Buchbinder, and Hetrick (2005) completed grade mobilization techniques compared with low-grade a Level I systematic review of therapeutic interventions mobilization for the improvement of shoulder mobility for painful shoulder conditions, including rotator cuff and reduction of self-reported disability in patients with tears. The evidence to support exercise, mobilization, and pulsed electromagnetic field for patients with rotator cuff The results of the Level I RCTs provide limited evi- tears was weak. The authors also noted weak evidence dence to support manual therapy, specifically, the Cyriax against the use of laser therapy instead of corticosteroid method of joint manipulation coupled with friction mas- sage and high-grade mobilization, for patients with adhesive Because systematic reviews offer the highest level of evidence to guide clinical decision making in occupational Exercise. Exercise has been studied as an intervention therapy, it is noteworthy that no strong evidence supports for frozen shoulder as it relates to timing and intensity of or refutes any available intervention for patients with the prescribed program. Diercks and Stevens (2004) rotator cuff tears, including conservative versus surgical compared supervised neglect with an intensive physical therapy regimen in a sample of 77 patients with idio-pathic frozen shoulder. The study was a Level II quasi- experimental design using a successive cohort as a control Interventions for frozen shoulder were reviewed in one group. Less aggressive therapeutic techniques, such as Level I systematic review, three Level I RCTs, one Level II pendulum exercises, active exercises within the painless quasi-experimental design, and three Level III studies.
range, and tolerable functional activities, were shown to Clinicians should be cautious in how articles with Level II be more effective for patients with idiopathic frozen and Level III evidence are interpreted with regard to shoulder than those techniques that surpass the pain clinical decision making around occupational therapy threshold. Both treatment groups required ³12 mo to recover pain-free and functional glenohumeral ROM.
The American Journal of Occupational Therapy In contrast to the work of Diercks and Stevens termined, and the individual versus cumulative effects of (2004), Ju¨rgel et al. (2005) promoted exercise therapy of the subsequent DAs cannot be established.
higher intensity and duration to provide more significant Ryans, Montgomery, Galway, Kernohan, and McKane changes in patients with frozen shoulder. These authors (2005) investigated the effectiveness of intra-articular ste- completed a Level III case-control study on a sample of roid treatment and physiotherapy alone and in combina- 20 patients, examining shoulder active range of motion tion for patients with adhesive capsulitis. This Level I RCT (AROM), shoulder muscle maximal isometric force, and had a sample of 80 patients placed in one of four groups: endurance in patients with frozen shoulder in both the (1) injection and physiotherapy, (2) injection and no involved and the uninvolved extremity. Using a 4-wk physiotherapy, (3) physiotherapy, and (4) placebo. At the program of exercise, massage, and electrical therapy, the 16-wk time point, no significant differences were found researchers found ROM, force, and endurance to be sig- between interventions in any outcome measure.
nificantly less in the affected shoulder than in the un- The two Level III studies reported here provide weak affected shoulder and in control participants.
evidence to support the use of hydraulic distension and DAs The interpretation of these Level II and III studies coupled with therapeutic exercise to increase ROM in pa- must be pursued cautiously because of their lower levels of tients with adhesive capsulitis. These studies are limited by evidence and lack of randomization. Further investigation sample size and methodological design, decreasing their is required to support or refute timing and intensity of evidentiary support for occupational therapy intervention exercise programs used to treat frozen shoulder.
planning. Note that the Level I RCT pursued by Ryans et al.
Invasive Procedures. Occupational therapists often (2005) resulted in no significant differences between in- partner with surgeons to provide therapeutic interventions jections and therapy interventions alone or in combination.
immediately after invasive procedures, such as hydraulic The aforementioned studies reviewed for adhesive distension and distension arthrographies (DAs). Injec- capsulitis yielded limited evidence for manual therapy on tions are used during both of these procedures and can the basis of two Level I RCTs with moderate sample sizes.
also be used to introduce steroids into the glenohumeral In addition to these studies, Green et al. (2005) found weak evidence to support laser therapy for patients with Callinan et al. (2003) completed a Level III pretest– adhesive capsulitis in a systematic review of therapeutic posttest design with a sample of 60 patients with interventions for painful shoulder conditions. Further re- idiopathic adhesive capsulitis. For the purposes of the search is required to determine the effective intensity of study, a hydraulic distension technique (hydroplasty) was therapeutic exercise for this condition.
combined with a therapy program. The researchers sug- gested that the use of a hydroplasty procedure combinedwith therapeutic intervention is a safe and effective treat- One Level I systematic review was found that addressed ment of idiopathic adhesive capsulitis. Significant increases the effectiveness of conservative management as a primary were noted for all AROM measures both immediately strategy in the treatment of shoulder instability. Gibson, after hydroplasty and at discharge (p < .001). The average Growse, Korda, Wray, and MacDermid (2004) reviewed cost of the hydroplasty protocol was calculated to be 42% 14 randomized, quasirandomized, cohort studies or case less than surgical manipulation with follow-up therapy.
series of adults with a history of shoulder instability Piotte et al. (2004) designed a study that aimed to treated with nonoperative management. The authors in- analyze the combined effectiveness of repeated DAs with dicated that weak evidence supports a conservative pro- a home exercise program for patients with adhesive cap- gram for shoulder instability that includes a 3- to 4-wk sulitis of the shoulder. This Level III repeated-measures immobilization period followed by 12 wk of ROM and design included a sample of 15 patients. A significant stability exercises; neither ROM nor stability exercises improvement was found with all measures at the con- used in isolation was recommended. Electromyographic clusion of intervention: The greatest significant effects biofeedback was weakly recommended as an adjunctive occurred after the first DA; less marked yet significant modality. The authors did not, however, recommend effects occurred after the second DA; and minimal effects conservative management over surgical intervention for occurred after the third DA. After intervention, signifi- decreasing recurrence of instability.
cant differences in ROM were noted compared with the contralateral side. This study used a repeated-measuresdesign with no controls. For this reason, the effectiveness One Level I systematic review on various methods of of DA versus home exercise programs cannot be de- treating proximal humerus fractures was located. Handoll, January/February 2011, Volume 65, Number 1 Gibson, and Madhok (2003) systematically reviewed 12 design and level of evidence, applicability of these results studies and suggested that limited evidence supports de- to intervention planning is limited.
cision making for the management of proximal humeralfractures. The researchers found minimal evidence that immediate therapy resulted in less pain and both fasterand better recovery for patients with nondisplaced two- Level I evidence, as characterized by systematic reviews and part fractures, that mobilization at 1 wk alleviated short- RCTs, provides the highest level of support for occupa- term pain, and that patients could achieve a satisfactory tional therapy interventions. In this systematic review, outcome without supervised therapy. The researchers limited evidence was found to support exercise for concluded that early therapeutic intervention without shoulder pain; manual therapy and laser therapy for ad- immobilization might be appropriately pursued by oc- hesive capsulitis; conservative management of shoulder cupational therapists for specific, nondisplaced fractures.
instability; early intervention without immobilization forspecific, nondisplaced proximal humerus fractures; andexercise, joint mobilizations, and laser therapy for patients Michener, Walsworth, and Burnet (2004) pursued aLevel I systematic review of 12 studies to determine the Discussion and Implications for Practice, efficacy of nonsurgical and nonpharmacologic rehabili-tation of subacromial impingement syndrome. The au- thors suggested that limited evidence supports exerciseand joint mobilizations for patients with subacromial impingement syndrome. In addition, laser therapy ap- This systematic review provides support for the use of pears to be beneficial when used in isolation, the use of multiple types of interventions by occupational therapists ultrasound for this population was not supported, and to treat conditions of the shoulder complex. Most in- acupuncture yielded equivocal results.
terventions covered in this review are defined as pre- Ludewig and Borstad (2003) implemented and paratory activities, or those that prepare patients for evaluated a specific therapeutic exercise program in a occupational performance. Recognizing that these inter- sample of 103 construction workers. This program was ventions represent a limited component of the types of intended to modify shoulder elevation and muscle activity interventions used by occupational therapists is of the abnormalities as they related to shoulder impingement.
utmost importance. Purposeful and occupation-based This Level I RCT supported the use of shoulder home activities should be used to facilitate a holistic treatment exercise programs to improve shoulder function and plan that focuses on return to ADLs, IADLs, work, ed- reductions in symptoms for construction workers who have routine exposure to overhead work.
Preparatory activities supported by this review include The results of these two Level I studies provided limited evidence for exercise, joint mobilizations, and laser therapy ROM and exercise, conservative management, joint mo- in isolation for patients with shoulder impingement.
bilization, laser therapy, electromyographic feedback, pulsedelectromagnetic field, and the Cyriax and Feldenkraismethods. ROM and exercise are supported for patients with rotator cuff tears, shoulder instability, proximal humerus Novak, Collins, and Mackinnon (1995) evaluated long- fractures, subacromial impingement syndrome, trapezius term subjective outcomes after conservative manage- myalgia, chronic neck or shoulder pain, frozen shoulder, and ment of 42 patients with thoracic outlet syndrome. This thoracic outlet syndrome. Joint mobilizations are supported Level III cross-sectional survey included an asymptomatic for patients with subacromial impingement syndrome and control group, a symptomatic control group, and a adhesive capsulitis. In this literature review, laser treatments symptomatic intervention group that used posture are supported only for patients with adhesive capsulitis; laser modification and a specific physical therapy program.
treatments were not found to be more effective than al- The home exercise program was found to reduce pain in ternative methods for treating clients with rotator cuff tears the proximal regions of the body, and the effectiveness of and shoulder pain. Weak evidence was found to support conservative management in treating thoracic outlet both electromyographic feedback for patients with shoulder syndrome was supported by this study. Because of the instability and pulsed electromagnetic field for patients with The American Journal of Occupational Therapy calcific tendonitis and rotator cuff tears. The Cyriax method lacked specificity regarding intervention approaches.
of deep friction massage and joint manipulations was found Issues in methodological quality included lack of ran- to be beneficial in terms of motion, pain, and treatment time domization, blinding, control groups, and long-term for patients with adhesive capsulitis.
When comparing the benefits of surgical and conser- vative management, the implementation of occupational therapy intervention is supported for patients with shoulder This systematic review provides limited evidence to sup- instability, subacromial impingement syndrome, and tho- port multiple preparatory activities that can be imple- mented by occupational therapists in the rehabilitation of people with work-related injuries and clinical conditions ofthe shoulder. Level I evidence was found to offer limited As the impetus toward evidence-based medicine continues, support for exercise, manual therapy, and laser therapy as the use of systematic reviews as an educational tool will adjunctive methods, with early intervention and conser- increase the efficacy of the profession as a whole. Students vative management supported as treatment approaches.
should be trained to be reflective consumers of the litera- Further research on occupation-based interventions for ture, using systematic reviews such as this one to evaluate clients with conditions of the shoulder complex is sug- the effectiveness of their intervention choices. In addition, the compilation of systematic reviews as part of the edu-cational process will contribute to both the literature base in occupational therapy and the pursuit of best practice as Arbesman, M., Lieberman, D., & Thomas, V. J. (2011).
part of the greater health care community. Because the Methodology for the systematic reviews on occupational future of the profession lies in the hands of students, therapy for people with work-related injuries and ill- familiarizing them with the content and construction of nesses. American Journal of Occupational Therapy, 65, systematic reviews will provide lasting benefit.
Bingo¨l, U., Altan, L., & Yurtkuran, M. (2005). Low-power laser treatment for shoulder pain. Photomedicine and LaserSurgery, 23, 459–464. doi: 10.1089/pho.2005.23.459 The literature reviewed here provides foundational in- Bot, S. D., van der Waal, J. M., Terwee, C. B., van der Windt, formation on which the profession of occupational therapy D. A., Scholten, R. J., Bouter, L. M., et al. (2005). Pre- can build interventions but, more important, suggests di- dictors of outcome in neck and shoulder symptoms: A rection for continued research. Further prospective studies cohort study in general practice. Spine, 30, E459–E470.
doi: 10.1097/01.brs.0000174279.44855.02 are necessary to delineate specific surgical and therapeutic Callinan, N., McPherson, S., Cleaveland, S., Voss, D. G., variables that facilitate positive outcomes in the treatment of Rainville, D., & Tokar, N. (2003). Effectiveness of hydro- patients with shoulder conditions. Such studies should not plasty and therapeutic exercise for treatment of frozen be limited to preparatory activities but should instead en- shoulder. Journal of Hand Therapy, 16, 219–224. doi: compass the holistic nature of occupational therapy practice.
More specifically, research pertaining to the efficacy and Diercks, R. L., & Stevens, M. (2004). Gentle thawing of the frozen shoulder: A prospective study of supervised neglect effectiveness of occupation-based interventions is suggested versus intensive physical therapy in seventy-seven patients as a means to promote and validate the profession.
with frozen shoulder syndrome followed up for two years.
Journal of Shoulder and Elbow Surgery, 13, 499–502. doi: Ejnisman, B., Andreoli, C. V., Soares, B. G. O., Fallopa, F., Most articles reviewed herein were Level I evidence, Peccin, M. S., Abdalla, R. J., et al. (2005). Interventions including seven systematic reviews and nine RCTs.
for tears of the rotator cuff in adults. Cochrane Database of As levels of evidence increase, the confidence with which occupational therapists can consider the results Geraets, J. J., Goossens, M. E. J. B., de Groot, I. J. M., de and implications of research increases as well. Limi- Bruijn, C. P. C., de Bie, R. A., Dinant, G.-J., et al. (2005).
tations of the studies selected for this review included Effectiveness of a graded exercise therapy program forpatients with chronic shoulder complaints. Australian small sample sizes, limited generalization to the greater Journal of Physiotherapy, 51, 87–94.
population, and limited statistical analyses. Some Gibson, K., Growse, A., Korda, L., Wray, E., & MacDermid, studies used an intervention period that may have been J. C. (2004). The effectiveness of rehabilitation for non- too short to appropriately assess clinical change; others January/February 2011, Volume 65, Number 1 systematic review. Journal of Hand Therapy, 17, 229–242.
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Reilingh, M. L., Kuijpers, T., Tanja-Harfterkamp, A. M., & van der Windt, D. A. (2008). Course and prognosis of Karjalainen, K., Malmivaara, A., van Tulder, M., Roine, R., shoulder symptoms in general practice. Rheumatology, 47, Jauhiainen, M., Hurri, H., et al. (2005). Multidisciplinary 724–730. doi: 10.1093/rheumatology/ken044 biopsychosocial rehabilitation for neck and shoulder pain Ryans, I., Montgomery, A., Galway, R., Kernohan, W. G., & among working age adults. Cochrane Database of System- McKane, R. (2005). A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoul- Kaskutas, V., & Snodgrass, J. (2009). Occupational therapy prac- der capsulitis. Rheumatology, 44, 529–535. doi: 10.1093/ tice guidelines for individuals with work-related injuries and illnesses. Bethesda, MD: AOTA Press.
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