Authors of a new clinical practice guideline (CPG) on treatment of shoulder pain took a hard look at the advisability of surgery and came to a conclusion that can be boiled down to 3 words: don’t do it.
Published in BMJ, the CPG focuses on adults with a traumatic shoulder pain lasting for 3 months or more (diagnosed as subacromial pain syndrome, or SAPS), and zeroes in on the effectiveness of arthroscopic decompression surgery versus nonsurgical approaches including exercise therapy, analgesics, and injections. The CPG development group, which included patients who had experienced SAPS, analyzed results of 2 systematic reviews—one on what constitutes a “minimally critically important difference” (MCID) in patient-reported outcomes, and another on the benefits and harms of decompression surgery. The systematic reviews included 7 trials involving 1, 014 patients.
In reviewing the systematic review of MCIDs for SAPS, the CPG group identified, with confidence, 2 changes that patients value: a difference in pain of at least 1.5 points on a visual 1-10 scale, and a difference in function of at least 8.3 units on a 100-point scale. In both areas, decompression surgery resulted in no significant differences from other approaches—including placebo surgery. The lack of difference remained at 6-month, 2-year, and 5-year follow ups.
APTA will provide financial and training support for the development of clinical practice guidelines (CPGs) for physical therapist practice, but proposals need to be submitted by September 15 to be considered in this review cycle.
Proposals for CPG development must focus on clinical practice areas that are important and relevant to the practice of physical therapy, and be supported and submitted by an APTA section. Each proposal will be considered individually, and awards of up to $10,000 may be granted based on the relevance to practice and the strength of the proposal.
The federal government’s official clearinghouse for practice guidelines will adopt more stringent standards for acceptance in the coming months. The new standards, adopted from the Institute of Medicine (IOM), include requirements for content, authorship, methodology, format, accessibility, and currency.
The Agency for Healthcare Research and Quality’s National Guideline Clearinghouse (NGC) will implement the new standards beginning June 1. The changes result from a 2008 directive from the federal government for IOM to identify best practice for developing clinical practice guidelines (CPGs). A full report, titled Clinical Practice Guidelines we can trust is available at the IOM website.