Archives of physical medicine and rehabilitation · 2026
Comparison of the Efficacy of Hyaluronic Acid Versus Corticosteroids, Platelet-Rich Plasma, and Physical Therapy in Chronic Shoulder Pain: A Systematic Review and a Frequentist Network Meta-Analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisСравнительное исследованиеОбзорНазвание и аннотация: Перевод пока не подготовлен
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Marra Annachiara, de Siena Andrea Uriel, Iacovazzo Carmine, Bianco Angela Rita, Squillacioti Francesco, Vargas Maria, Buonanno Pasquale
Аннотация
OBJECTIVE: To compare the effectiveness of injected low- and high-molecular-weight hyaluronic acid (HA-LMW, HA-HMW) versus corticosteroids (CCS), placebo-or physical therapy (PT), on pain at rest (Prest), at night (Pnight), and during activity (Pact), range of motion (ROM), functional status (FS), and quality of life in patients with chronic shoulder pain (Sp) at 3 and 6 months follow-up.
DATA SOURCES: A systematic literature search was conducted through October 2024 across MEDLINE, Embase, and Cochrane CENTRAL.
STUDY SELECTION: Fourteen studies were included: 12 randomized controlled trials and 2 prospective cohort studies that compared at least 2 of the treatments of interest in adults with chronic Sp.
DATA EXTRACTION: Two reviewers independently extracted data related to the outcomes.
DATA SYNTHESIS: A frequentist network meta-analysis with mean differences (MDs) and standardized mean differences (SMD) was performed; P<.05 was statistically significant. PT reduced Prest compared to HA-HMW (MD = -3.02, P<.01 at 3 mo; MD = -2.08, P<.01 at 6 mo) and HA-LMW (MD = -1.95, P<.01 at 6 mo) in tendinopathy. PT showed greater reduction than both HA formulations in Pnight and Pact at 6 months in tendinopathy. No differences were observed between HA-HMW and HA-LMW for pain outcomes considering shoulder different diseases. HA improved adduction and internal rotation at 3 months considering shoulder different disease; PT was superior for flexion and external rotation at 6 months in tendinopathy. Stratified by pathology, HA-HMW showed moderate efficacy in adhesive capsulitis. HA-HMW improved FS compared to HA-LMW at 3 months. CCS improved abduction in shoulder disease due to different causes.
CONCLUSIONS: PT provides greater pain control for Sptendinopathy, particularly for Prest, Pnight, and Pact at both 3 and 6 months. HA may contribute to improved quality of life and specific ROM parameters. Further high-quality studies are required to consolidate these findings.
DATA SOURCES: A systematic literature search was conducted through October 2024 across MEDLINE, Embase, and Cochrane CENTRAL.
STUDY SELECTION: Fourteen studies were included: 12 randomized controlled trials and 2 prospective cohort studies that compared at least 2 of the treatments of interest in adults with chronic Sp.
DATA EXTRACTION: Two reviewers independently extracted data related to the outcomes.
DATA SYNTHESIS: A frequentist network meta-analysis with mean differences (MDs) and standardized mean differences (SMD) was performed; P<.05 was statistically significant. PT reduced Prest compared to HA-HMW (MD = -3.02, P<.01 at 3 mo; MD = -2.08, P<.01 at 6 mo) and HA-LMW (MD = -1.95, P<.01 at 6 mo) in tendinopathy. PT showed greater reduction than both HA formulations in Pnight and Pact at 6 months in tendinopathy. No differences were observed between HA-HMW and HA-LMW for pain outcomes considering shoulder different diseases. HA improved adduction and internal rotation at 3 months considering shoulder different disease; PT was superior for flexion and external rotation at 6 months in tendinopathy. Stratified by pathology, HA-HMW showed moderate efficacy in adhesive capsulitis. HA-HMW improved FS compared to HA-LMW at 3 months. CCS improved abduction in shoulder disease due to different causes.
CONCLUSIONS: PT provides greater pain control for Sptendinopathy, particularly for Prest, Pnight, and Pact at both 3 and 6 months. HA may contribute to improved quality of life and specific ROM parameters. Further high-quality studies are required to consolidate these findings.