Is multimodal care effective for the management of patients with soft tissue injuries of the shoulder? A systematic review of the literature
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Shoulder injuries are common and cause significant pain and disability. Individuals who consult clinicians for shoulder pain are typically treated with multimodal care. However, little is known about the effectiveness of multimodal care. This systematic review examines the effectiveness of multimodal care for soft tissue shoulder injuries. Five databases were systematically searched, 5885 articles were screened, and 19 were critically appraised. The best-evidence synthesis includes ten high-quality RCTs. For subacromial impingement syndrome, multimodal care leads to similar outcomes as sham therapy, shock-wave therapy, corticosteroid injections and surgery. For rotator cuff tendinitis, a multimodal program (acupuncture, dietary advice, and enzyme tablets) is more effective than conventional care (supervised exercise, soft tissue therapy, manual therapy, and placebo tablets). For non-specific shoulder pain, multimodal care may be more effective than waitlist, but leads to similar outcomes as exercise or corticosteroid injections. Future research is needed to determine the effectiveness of multimodal care.