BJSM - 2026-05-14 - Journal Article
Comparative effectiveness of physical therapy interventions in adults with rotator cuff tendinopathy: a systematic review and network meta-analysis.
Lazzarini SG, Bettariga F, Mosconi B, Maestroni L, Cordani C, Bandini E, Dal Farra F, Lopez P, Arienti C
Topics
Key Takeaway
In 89 RCTs of rotator cuff tendinopathy, exercises plus percutaneous electrolysis produced the greatest pain reduction (SMD -1.58) and exercises plus trigger point dry needling the greatest functional improvement (SMD 3.10) versus no treatment, though evidence certainty was very low across all comparisons.
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Summary
This NMA compared all physical therapy interventions for RC tendinopathy across 89 RCTs to rank effectiveness on pain, function, QoL, and adverse events. Isolated shoulder exercises reduced pain (SMD -0.79) and improved function (SMD 0.74) versus no treatment; adjunctive percutaneous electrolysis and trigger point dry needling produced the largest effect sizes for pain and function, respectively. GRADE certainty was very low for most comparisons, and most adjunctive interventions were not superior to exercise alone.
Key Limitation
Very low GRADE certainty for the majority of comparisons—driven by high risk of bias and limited data per node—means the large effect sizes for percutaneous electrolysis and dry needling combinations cannot be reliably translated into practice.
Original Abstract
OBJECTIVE
To compare the effects of different physical therapy interventions and identify the most effective intervention on pain, function, quality of life (QoL) and adverse events (AEs) in adults with rotator cuff (RC) tendinopathy.
DESIGN
Systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs).
DATA SOURCES
Seven databases and two trial registries were searched up to March 2024. ELIGIBILITY
CRITERIA FOR SELECTING STUDIES
RCTs comparing physical therapy interventions to any other physical therapy intervention, sham, placebo, waiting list or no treatment on pain, function, QoL and AEs in adults with RC tendinopathy.
DATA SYNTHESIS
A frequentist NMA using a random-effects model was performed. Risk of bias and certainty of the evidence were assessed using the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively.
RESULTS
89 RCTs (5532 participants) were included. Exercises targeting the shoulder muscles may reduce pain (standardised mean difference (SMD) -0.79, 95% CI -1.33 to -0.26) and improve function (SMD 0.74, 95% CI 0.34 to 1.14) compared with no treatment but the evidence is very uncertain. Exercises targeting shoulder and scapular muscles in addition to percutaneous electrolysis (SMD -1.58, 95% CI -2.68 to -0.48) and to trigger point dry needling (SMD 3.10, 95% CI 1.99 to 4.22) seem to be the most effective interventions on pain and function at the end of treatment, respectively.
CONCLUSION
Most of the interventions identified may not be superior to isolated shoulder exercises alone, which might be considered a reasonable first-line approach, but the evidence is very uncertain and most interventions are informed by limited data. High-quality research is needed to improve evidence of physical therapy interventions in adults with RC tendinopathy.
PROSPERO REGISTRATION NUMBER
CRD42024527176.