Faculty Opinions recommendation of Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.

AbstractClinical questionDo adults with atraumatic shoulder pain for more than 3 months diagnosed as subacromial pain syndrome (SAPS), also labelled as rotator cuff disease, benefit from subacromial decompression surgery? This guideline builds on to two recent high quality trials of shoulder surgery.Current practiceSAPS is the common diagnosis for shoulder pain with several first line treatment options, including analgesia, exercises, and injections. Surgeons frequently perform arthroscopic subacromial decompression for prolonged symptoms, with guidelines providing conflicting recommendations.RecommendationThe guideline panel makes a strong recommendation against surgery.How this guideline was createdA guideline panel including patients, clinicians, and methodologists produced this recommendation in adherence with standards for trustworthy guidelines and the GRADE system. The recommendation is based on two linked systematic reviews on (a) the benefits and harms of subacromial decompression surgery and (b) the minimally important differences for patient reported outcome measures. Recommendations are made actionable for clinicians and their patients through visual overviews. These provide the relative and absolute benefits and harms of surgery in multilayered evidence summaries and decision aids available in MAGIC (www.magicapp.org) to support shared decisions and adaptation.The evidenceSurgery did not provide important improvements in pain, function, or quality of life compared with placebo surgery or other options. Frozen shoulder may be more common with surgery.Understanding the recommendationThe panel concluded that almost all informed patients would choose to avoid surgery because there is no benefit but there are harms and it is burdensome. Subacromial decompression surgery should not be offered to patients with SAPS. However, there is substantial uncertainty in what alternative treatment is best.

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Arthroscopic subacromial decompression: Analysis of results of 1–3 years

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(87)80040-3 ◽

1987 ◽

Vol 3 (2) ◽

pp. 133 ◽

Cited By ~ 1

Keyword(s):

Subacromial Decompression ◽

Analysis Of Results ◽

Arthroscopic Subacromial Decompression

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Subacromial decompression surgery for shoulder pain

BMJ ◽

10.1136/bmj.l586 ◽

2019 ◽

pp. l586

Author(s):

Nick A Aresti ◽

Livio Di Mascio

Keyword(s):

Shoulder Pain ◽

Decompression Surgery ◽

Subacromial Decompression

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High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: A prospective study of 50 patients

Acta Orthopaedica ◽

10.1080/17453670610045821 ◽

2006 ◽

Vol 77 (1) ◽

pp. 138-142 ◽

Cited By ~ 19

Author(s):

Marie Bengtsson ◽

Karl Lunsjö ◽

Ylva Hermodsson ◽

Anders Nordqvist ◽

Fikri M Abu-Zidan

Keyword(s):

Patient Satisfaction ◽

Prospective Study ◽

Subacromial Decompression ◽

High Patient Satisfaction ◽

Shoulder Impingement ◽

Arthroscopic Subacromial Decompression ◽

A Prospective Study

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Minimal important differences for improvement in shoulder condition patient-reported outcomes: a systematic review to inform aBMJRapid Recommendation

BMJ Open ◽

10.1136/bmjopen-2018-028777 ◽

2019 ◽

Vol 9 (2) ◽

pp. e028777 ◽

Cited By ~ 21

Author(s):

Qiukui Hao ◽

Tahira Devji ◽

Dena Zeraatkar ◽

Yuting Wang ◽

Anila Qasim ◽

...

Keyword(s):

Systematic Review ◽

Shoulder Pain ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Decompression Surgery ◽

Subacromial Decompression ◽

Review Team ◽

Patient Reported ◽

Minimal Important Differences

ObjectivesTo identify credible anchor-based minimal important differences (MIDs) for patient-reported outcome measures (PROMs) relevant to aBMJRapid Recommendations addressing subacromial decompression surgery for shoulder pain.DesignSystematic review.Outcome measuresEstimates of anchor-based MIDs, and their credibility, for PROMs judged by the parallelBMJRapid Recommendations panel as important for informing their recommendation (pain, function and health-related quality of life (HRQoL)).Data sourcesMEDLINE, EMBASE and PsycINFO up to August 2018.Study selection and review methodsWe included original studies of any intervention for shoulder conditions reporting estimates of anchor-based MIDs for relevant PROMs. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria. Six reviewers, working in pairs, independently extracted data from eligible studies using a predesigned, standardised, pilot-tested extraction form and independently assessed the credibility of included studies using an MID credibility tool.ResultsWe identified 22 studies involving 5562 patients that reported 74 empirically estimated anchor-based MIDs for 10 candidate instruments to assess shoulder pain, function and HRQoL. We identified MIDs of high credibility for pain and function outcomes and of low credibility for HRQoL. We offered median estimates for the systematic review team who applied these MIDs in Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence summaries and in their interpretations of results in the linked systematic review addressing the effectiveness of surgery for shoulder pain.ConclusionsOur review provides anchor-based MID estimates, as well as a rating of their credibility, for PROMs for patients with shoulder conditions. The MID estimates inform the interpretation for a linked systematic review and guideline addressing subacromial decompression surgery for shoulder pain, and could also prove useful for authors addressing other interventions for shoulder problems.PROSPERO registration numberCRD42018106531.

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