Evidence-based Sports Medicine

Evidence-based Sports MedicineSummarising the evidenceComparison/treatment Results Level ofstrategiesevidence*Corticosteroids versus 13 RCTs, none of moderate size, pooled A1placeboestimate in favour of corticosteroids(short-term only).Corticosteroids versus 4 RCTs, none of moderate size, A3analgesicsconflicting results.Physiotherapy: exercises/ 4 RCTs, one of moderate size, A3mobilisationspooling not possible, results infavour of exercises.Corticosteroids versus 4 RCTs, one of moderate size, A3physiotherapypooled estimate in favour ofcorticosteroids (short-term only).* A1: evidence from large RCTs or systematic review (including metaanalysis)†A2: evidence from at least one high quality cohortA3: evidence from at least one moderate size RCT or systematic review †A4: evidence from at least one RCTB: evidence from at least one high quality study of non-randomised cohortsC: expert opinions† Arbitrarily, the following cut-off points have been used; large study size: ≥ 100patients per intervention group; moderate study size ≥ 50 patients perintervention group.References1 Badley EM, Tennant A. Changing profile of joint disorders with age: findings froma postal survey of the population of Calderdale, West Yorkshire, United Kingdom.Ann Rheum Dis 1992;51:366–71.2 Bjelle A. Epidemiology of shoulder problems. Baillière’s Clin Rheumatol 1989;3:437–51.3 Croft P. Soft tissue rheumatism. In: Silman AJ, Hochberg MC (eds). Epidemiology ofthe rheumatic diseases, Ch 15. Oxford: Oxford Medical Publications, 1993:375–421.4 Van der Windt DAWM, Koes BW, De Jong BA, Bouter LM. Shoulder disorders ingeneral practice: incidence, patient characteristics, and management. Ann RheumDis 1995;54:959–64.5 Miedema HS. Reuma-onderzoek meerdere echelons (ROME): basisrapport. Leiden:Nederlands Instituut voor Praeventieve Gezondheidszorg TNO, 1994.6 Nygren A, Berglund A, Von Koch M. Neck-and-shoulder pain, an increasingproblem. Strategies for using insurance material to follow trends. Scand J RehabilMed Suppl 1995;32:107–12.7 Uhthoff HK, Sarkar K. An algorithm for shoulder pain caused by soft-tissuedisorders. Clin Orthop 1990;254:121–7.8 Zuckerman JD, Mirabello SC, Newman D, Gallagher M, Cuomo F. The painfulshoulder: part I. Extrinsic disorders. Am Fam Physician 1991;43:119–28.9 Zuckerman, JD, Mirabello SC, Newman D, Gallagher M, Cuomo F. The painfulshoulder: Part II. Intrinsic disorders and impingement syndrome. Am FamPhysician 1991;43:497–512.10 Van der Windt DAWM, Koes BW, Boeke AJP, Devillé W, De Jong BA, Bouter LM.Shoulder disorders in general practice: prognostic indicators of outcome. Br J GenPract 1996;46:519–23.314