Efficacy and cost-effectiveness of physiotherapy for chronic rotator cuff pathology

肩部疾病很常见，仅次于背部和颈部的肌肉骨骼疾病，是就医的第三大原因，占所有物理治疗转介的10%。肩部疼痛影响多达2%-5%的总人口，在中老年更为常见。最常见的肩部疾病之一是慢性肩袖病变。这会导致严重的疼痛和残疾，限制日常生活活动以及工作、睡眠和休闲。40%的患者将在3年后继续出现症状，15%的患者将持续残疾，可能需要手术治疗。由于这种疾病很普遍，它给澳大利亚的医疗保健系统带来了相当大的负担。物理疗法是一种常见的保守治疗方案，但其疗效尚未得到很好的证实。Cochrane最近对文献的回顾揭示了许多现有研究存在的几个问题：(I)人群包括多种肩部诊断类别；(Ii)研究设计存在重大缺陷；(Iii)评估的是单一的物理治疗模式，而不是像目前的临床实践那样的综合计划。因此，这项涉及200名参与者的新颖研究项目将回答有关物理治疗计划对慢性肩袖病理的有效性以及是否可以保持益处的重要问题。此外，它还将确定物理治疗的费用是否物有所值，这在当今的经济环境下是重要的。这个项目的结果可以很容易地立即转化为临床实践，因为可以就物理治疗对这一患者群体的有效性提出建议。这一结果将不仅对物理治疗专业，而且对医疗专业都有很大的好处，他们必须证明病人被转介到物理治疗以及资助和可补偿的机构是合理的。

Shoulder disorders are common, being third only to back and neck complaints as musculoskeletal reasons for medical consultation and accounting for 10% of all physiotherapy referrals. The painful shoulder affects up to 2-5% of the general population, being more common in middle to older age. One of the most common shoulder disorders is chronic rotator cuff pathology. This causes significant pain and disability that restricts activities of daily living as well as work, sleep and leisure. Forty percent of sufferers will continue to have symptoms beyond 3 years and 15% will have persistent disability which may require surgical intervention. Because this disorder is prevalent, it imposes a considerable burden on the Australian health care system. Physiotherapy is a common conservative treatment option but its efficacy has not been well established. A recent Cochrane review of the literature revealed several problems with many of the existing studies: (i) the populations have included a mix of shoulder diagnostic categories; (ii) the research designs have major flaws and (iii) a single physiotherapy modality has been evaluated rather than a combined program as is current clinical practice. Thus, this novel research project involving 200 participants will answer important questions about the efficacy of a physiotherapy program for chronic rotator cuff pathology and whether benefits can be maintained. In addition it will determine whether the costs of physiotherapy represent good value for money which is important in today's economic climate. The results of this project can be easily and immediately translated into clinical practice as recommendations can be made about the usefulness of physiotherapy for this patient population. The results will be of major benefit not just to the physiotherapy profession but to the medical profession who must justify patient referral to physiotherapy and to funding and compensable bodies.