ReviewLack of uniformity in diagnostic labeling of shoulder pain: Time for a different approach
Introduction
In the past many subgroups have been suggested in people with shoulder pain with enhancement of treatment success as one of the aims (e.g., frozen shoulder, rotator cuff tendinitis, impingement syndrome). About 10 years ago, however, it was shown that the specific criteria for each of those subgroups were not uniformly defined (Green et al., 1998).
In order to systematically evaluate the efficacy and effectiveness of therapeutic interventions for shoulder pain, it is necessary to compare the results of different studies. However, if the lack of unambiguous definitions still exists today, this, would seriously hamper inter-study comparison.
Diagnostic labels are still frequently used in intervention research on shoulder pain. Therefore, this review aims to assess the uniformity of criteria used in intervention research to define diagnostic labels for subgroups of patients with shoulder pain.
Section snippets
Selection criteria
Since one of the main goals of the diagnostic labels is to enhance treatment success, we focused on the main tool of intervention research: i.e., randomised controlled trials (RCTs). An RCT was included in the present review only when it concerned an intervention for shoulder pain with a specific diagnostic label. There were no restrictions on the kind of intervention or the population being studied, based on the assumption that sociodemographic factors do not affect the definitions of the
Results
Our search strategy resulted in the following hits per database: Cochrane CENTRAL 1401 articles, Cochrane database of systematic reviews 40 articles, and Medline 2603 articles. Of all these articles, 66 met our criteria.
A total of 13 different diagnostic labels were found (Table 1), which we combined into five main groups based on the similarities of names and the way the names are used interchangeably.
Discussion
Despite the frequent use of diagnostic labels for shoulder pain, there still seem to be no generally applied criteria for each of those labels. Although our search was limited to RCTs, we consider it likely that the same conclusion can be drawn from studies with a different design. This assumption is supported by a study comparing diagnostic criteria for rotator cuff tendinitis and adhesive capsulitis in epidemiologic surveys (Walker-Bone et al., 2003).
The lack of uniformity may be an important
Acknowledgement
No financial or material support for the research and the work was received.
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