Efficacy of treatment for subacromial pain in older adults: a systematic review and meta-analysis with GRADE recommendations.

UNLABELLED: Subacromial pain is a prevalent musculoskeletal condition that impairs shoulder function, particularly in older adults. It is often associated with tendinopathy, bursitis, and biomechanical dysfunction, leading to limitations in daily activities and decreased quality of life. Despite its clinical relevance, studies targeting individuals aged 60 years and older are scarce. The aim of this review was to systematically synthesize the evidence from randomized controlled trials (RCTs) evaluating the effectiveness of conservative treatments for subacromial pain in adults aged 60 years and older.

METHODS

This review followed the Cochrane and PRISMA guidelines and was registered in PROSPERO (CRD42024591488). Six databases were searched without restrictions. Eligible RCTs compared therapeutic interventions to minimal intervention controls and reported outcomes on pain and/or disability. Risk of bias was assessed using the PEDro scale, and the certainty of evidence was rated using the GRADE approach. Meta-analyses were performed using random-effects models.

RESULTS

Out of 6,198 records, four RCTs met the inclusion criteria. Interventions included resistance training, cycle ergometer exercise, dry needling, and osteopathic manipulative treatment. The meta-analysis of three trials showed a statistically significant pooled effect for pain reduction (MD = -1.60; 95% CI: -3.16 to -0.04); however, two studies (resistance training and cycle ergometer) demonstrated significant individual benefits. The overall certainty of evidence ranged from low to high. No study assessed disability using validated upper limb-specific instruments.

CONCLUSIONS

Although some interventions demonstrated positive effects on pain, the overall evidence for conservative treatments in older adults with subacromial pain is limited. Further high-quality trials are needed, focusing on functional outcomes and long-term benefits.