Prognostic models in adults undergoing physiotherapy for rotator cuff disorders - a systematic review

Background: Rotator cuff related disorders represent the largest subgroup of shoulder complaints. Despite the availability of various conservative and surgical treatment options, the precise indications for these options remain unclear. Purpose: The purpose of this systematic review was to synthesize the available research on prognostic models for predicting outcomes in adults undergoing physiotherapy for painful rotator cuff disorders. Data sources: We searched Medline, Embase, Cinahl, Cochrane CENTRAL, PEDro and trial registries up to October 2015. Study selection: We included primary studies exploring prognostic models in adults undergoing physiotherapy, with or without other conservative measures, for painful rotator cuff disorders. Primary outcomes were pain, disability and adverse events. Inclusion was limited to prospective investigations of prognostic factors elicited at the baseline assessment. Study selection was independently performed by two reviewers. Data extraction: We used a piloted form to extract data on key aspects of study design, characteristics, analyses and results. Risk of bias and applicability was independently assessed by two reviewers using the PROBAST tool. Data synthesis: Five studies were included in the review. These were extremely heterogeneous in many aspects of design, conduct and analysis. The findings were analysed narratively. Limitations: All included studies were rated as at high risk of bias, and none of the resulting prognostic models was found to be usable in clinical practice. Conclusions: There are no prognostic models ready to inform clinical practice in the context of the review question, highlighting the need for further research on prognostic models for predicting outcomes in adults who undergo physiotherapy for painful rotator cuff disorders. The design and conduct of future studies should be receptive to developing methodologies.