Eficacia de la terapia manual más ejercicio terapéutico comparado con ejercicio terapéutico exclusivo para la disminución del dolor en usuarios con tendinopatía del manguito rotador revisión sistemática
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Fecha
2022
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es
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Universidad Andrés Bello
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Licencia CC
Licencia CC
Resumen
Introducción: la tendinopatía del manguito rotador (MR) es un trastorno musculoesquelético, que presenta una alteración del funcionamiento en la vida diaria, signos de dolor y pérdida del rango de movimiento (ROM). Hasta la fecha existe controversia en la literatura respecto a la eficacia de la terapia manual (TM) comparada con el ejercicio terapéutico con respecto a mejoras en los resultados clínicos mencionados. Objetivo: evaluar la eficacia reportada en literatura del ejercicio terapéutico acompañado de TM respecto al ejercicio terapéutico exclusivo para la disminución de dolor, ROM, funcionalidad, retorno a la actividad y prevalencia de hombro congelado en adultos en edad laboral. Métodos de búsqueda: se realizó una revisión sistemática en 4 bases de datos (Pubmed, Epistemonikos, Lilacs y WoS) en los cuales se utilizaron términos relacionados con dolor de hombro y los tratamientos mencionados, identificando ensayos clínicos aleatorizados (ECA) en los cuales se compare el ejercicio terapéutico acompañado de terapia manual versus el ejercicio terapéutico exclusivo, en idioma inglés y español desde el año 2015 en adelante. Se utilizó escala de PEDro para evaluar la calidad metodológica de los estudios. Criterios de selección: fueron elegidos estudios en población adulta, edad entre 18 y 65 años, con diagnóstico de tendinopatía del MR, en los cuales se comparó TM más ejercicio terapéutico respecto al ejercicio terapéutico exclusivo en relación a la disminución del dolor, cambio en ROM, funcionalidad, retorno a la actividad y prevalencia de hombro congelado, con diseño metodológico de ECA, en idioma inglés y/o español, y sin límite de antigüedad. Recolección de datos y análisis: se realizó análisis cualitativo de los artículos seleccionados, de los cuales se extrajo datos de tratamiento aplicado en grupo experimental y control, características clínicas de los usuarios, tiempo de seguimiento, y los resultados clínicos de interés: dolor, funcionalidad y prevalencia de hombro congelado. También se consideraron los sesgos de los artículos seleccionados. Principales resultados: se seleccionó solo 1 artículo ECA con nivel de evidencia 5 en escala de Pedro que compara TM más ejercicio terapéutico comparado con ejercicio terapéutico exclusivo en usuarios que presentaron post tendinopatía de hombro capsulitis adhesiva, demostrando disminución significativa de dolor, y aumento de ROM y funcionalidad en ambas intervenciones, pero sin diferencia entre ambos grupos. Conclusiones de los autores: se reporta escasa evidencia de baja calidad que apoya la futilidad de sumar terapia manual al ejercicio terapéutico para disminución de dolor, aumento de ROM y funcionalidad
Background: rotator cuff (RM) tendinopathy is a musculoskeletal disorder, which presents with impaired functioning in daily life, signs of pain and loss of range of motion (ROM). Actually, there is controversy in the literature regarding the efficacy of manual therapy (MT) compared to therapeutic exercise with respect to improvements in the aforementioned clinical outcomes. Objectives: to evaluate the reported efficacy of therapeutic exercise accompanied by MT compared to therapeutic exercise alone in reducing pain, ROM, function, return to activity and prevalence of frozen shoulder in adults of working age. Search methods: a systematic review was performed in 4 databases (Pubmed, Epistemonikos, Lilacs and WoS) in which terms related to shoulder pain and the mentioned treatments were used, identifying randomized clinical trials (RCT) in which therapeutic exercise accompanied by manual therapy versus exclusive therapeutic exercise is compared, in English and Spanish language from 2015 onwards. PEDro scale was used to evaluate the methodological quality of the studies. Selection criteria: studies were selected in adult population, aged between 18 and 65 years, with a diagnosis of RM tendinopathy, in which TM plus therapeutic exercise was compared with respect to exclusive therapeutic exercise in relation to pain reduction, change in ROM, functionality, return to activity and prevalence of frozen shoulder, with RCT methodological design, in English and/or Spanish, and with no age limit. Data collection and analysis: qualitative analysis of the selected articles was carried out, from which data were extracted on treatment applied in experimental and control groups, clinical characteristics of the users, follow-up time, and the clinical results of interest: pain, functionality and prevalence of frozen shoulder. The biases of the selected articles were also considered. Main results: only 1 RCT article was selected with level of evidence 5 in Pedro's scale comparing TM plus therapeutic exercise compared to exclusive therapeutic exercise in users with adhesive capsulitis, demonstrating a significant decrease in pain, and an increase in ROM and functionality in both interventions, but with no difference between the two groups. Authors' conclusions: low quality evidence is reported to support the futility of adding manual therapy to exercise therapy to decrease pain, increase ROM and function..
Background: rotator cuff (RM) tendinopathy is a musculoskeletal disorder, which presents with impaired functioning in daily life, signs of pain and loss of range of motion (ROM). Actually, there is controversy in the literature regarding the efficacy of manual therapy (MT) compared to therapeutic exercise with respect to improvements in the aforementioned clinical outcomes. Objectives: to evaluate the reported efficacy of therapeutic exercise accompanied by MT compared to therapeutic exercise alone in reducing pain, ROM, function, return to activity and prevalence of frozen shoulder in adults of working age. Search methods: a systematic review was performed in 4 databases (Pubmed, Epistemonikos, Lilacs and WoS) in which terms related to shoulder pain and the mentioned treatments were used, identifying randomized clinical trials (RCT) in which therapeutic exercise accompanied by manual therapy versus exclusive therapeutic exercise is compared, in English and Spanish language from 2015 onwards. PEDro scale was used to evaluate the methodological quality of the studies. Selection criteria: studies were selected in adult population, aged between 18 and 65 years, with a diagnosis of RM tendinopathy, in which TM plus therapeutic exercise was compared with respect to exclusive therapeutic exercise in relation to pain reduction, change in ROM, functionality, return to activity and prevalence of frozen shoulder, with RCT methodological design, in English and/or Spanish, and with no age limit. Data collection and analysis: qualitative analysis of the selected articles was carried out, from which data were extracted on treatment applied in experimental and control groups, clinical characteristics of the users, follow-up time, and the clinical results of interest: pain, functionality and prevalence of frozen shoulder. The biases of the selected articles were also considered. Main results: only 1 RCT article was selected with level of evidence 5 in Pedro's scale comparing TM plus therapeutic exercise compared to exclusive therapeutic exercise in users with adhesive capsulitis, demonstrating a significant decrease in pain, and an increase in ROM and functionality in both interventions, but with no difference between the two groups. Authors' conclusions: low quality evidence is reported to support the futility of adding manual therapy to exercise therapy to decrease pain, increase ROM and function..
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Proyecto de título (Kinesiólogo)
Palabras clave
Manguito de los Rotadores, Tendinopatía, Terapia