Clinical outcomes of a scapular-focused treatment in patients with subacromial pain syndrome : a systematic review

Objective: To systematically review the literature on the clinical outcomes of scapular-focused treatments in participants with subacromial pain syndrome (SPS). Design: Systematic literature review. Studies were appraised by two reviewers using the Physiotherapy Evidence Database (PEDro) scale, and a best-evidence synthesis was performed. Data sources: The literature search was conducted in the databases PubMed, Embase and Cinahl up to February 2015. Eligibility criteria for selecting studies: Randomised controlled trials evaluating the clinical outcomes of a physiotherapeutic scapular-focused treatment in participants with SPS. Results: Four studies were included describing various scapular-focused interventions, including scapularfocused exercise therapy, scapular mobilisation and scapular taping. All included studies had a PEDro score of 6 or higher, indicating low risk of bias. There was moderate evidence that scapular-focused treatment compared with other physiotherapeutic treatment is effective in improving scapular muscle strength in participants with SPS. Conflicting evidence was found for improvements in pain, function and clinical measures of scapular positioning. No evidence was found for improvements in shoulder range of motion or rotator cuff muscle strength. Conclusions: There is some support for the use of scapular-focused exercise therapy in patients with SPS. Owing to the low number of studies, no firm conclusions can be drawn. Therefore, more randomised controlled trials are needed to determine the clinical outcomes of scapular-focused exercise therapy, scapular mobilisation techniques and scapular taping in patients with SPS

The Association Between Preoperative Inspiratory Muscle Training Variables and Postoperative Pulmonary Complications in Subjects With Esophageal Cancer

BACKGROUND: Preoperative inspiratory muscle training (IMT) is frequently used in patients waiting for major surgery to improve respiratory muscle function and to reduce the risk of postoperative pulmonary complications (PPCs). Currently, the mechanism of action of IMT in reducing PPCs is still unclear. Therefore, we investigated the associations between preoperative IMT variables and the occurrence of PPCs in patients with esophageal cancer. METHODS: A multi-center cohort study was conducted in subjects scheduled for esophagectomy, who followed IMT as part of a prehabilitation program. IMT variables included maximum inspiratory pressure (PImax) before and after IMT and IMT intensity variables including training load, frequency, and duration. Associations between PImax and IMT intensity variables and PPCs were analyzed using independent samples t tests and logistic regression analyses, corrected for age and pulmonary comorbidities and stratified for the occurrence of anastomotic leakages. RESULTS: Eighty-seven subjects were included (69 males; mean age 66.7 6 7.3 y). A higher PImax (odds ratio 1.016, P = .07) or increase in PImax during IMT (odds ratio 1.020, P = .066) was not associated with a reduced risk of PPCs after esophagectomy. Intensity variables of IMT were also not associated (P ranging from .16 to .95) with PPCs after esophagectomy. Analyses stratified for the occurrence of anastomotic leakages showed no associations between IMT variables and PPCs. CONCLUSIONS: This study shows that an improvement in preoperative inspiratory muscle strength during IMT and training intensity of IMT were not associated with a reduced risk on PPCs after esophagectomy. Further research is needed to investigate other possible factors explaining the mechanism of action of preoperative IMT in patients undergoing major surgery, such as the awareness of patients related to respiratory muscle function and a diaphragmatic breathing pattern