What is the clinical effectiveness of home-based exercise programs compared to supervised physiotherapy on pain, function, and disability in patients with non-tears rotator cuff-related shoulder pain (RCRSP)?
AMSTAR Rating
Summary
Patient Population:
12 randomized controlled trials (RCTs) met eligibility criteria, encompassing a total sample size of N = 475 adult patients (55.4% female; mean age 51.5 years, range 42 to 65 years). All included participants presented with chronic shoulder pain localized to the glenohumeral region lasting >3 months (average symptom duration of 48.7 weeks) with positive clinical impingement signs and no full or partial rotator cuff tears.
Intervention:
Self-managed or home-based therapeutic exercise programs. Programs focused on rotator cuff and scapular stabilizer muscle strengthening using elastic resistance bands, free weights, or stretching/pendulum exercises, with an average intervention duration of 10.8 weeks (range 6 to 24 weeks; most commonly 12 weeks). In-person clinician supervision was strictly constrained to a maximum of one visit every four weeks solely for technique review or load progression.
Comparison:
Supervised exercise programs delivered individually or in group clinic sessions under direct physiotherapist supervision, either administered as isolated exercise therapy or combined with conventional multimodal physical therapy (manual therapy, soft tissue mobilization, taping, or electrotherapy).
Outcome:
Fixed- and random-effects meta-analyses at the primary 12-week endpoint demonstrated no statistically significant differences between home self-training and supervised physiotherapy across primary clinical metrics:
- Pain intensity (VAS): Standardized Mean Difference [SMD] = 0.92; 95% CI, 0.58 to 1.26; p = 0.66; I² = 69.5%. Both groups exceeded the established minimal important difference (MID of 1.5 points).
- Shoulder disability (SPADI): SMD = 1.00; 95% CI, 0.74 to 1.26; p = 0.93; I² = 0.0%.
- Functional capacity (Constant-Murley Score): SMD = -0.82; 95% CI, -1.05 to -0.60; p = 0.64; I² = 66.7%.
- Adherence: Only 6 of 12 studies reported adherence data, exclusively using self-reported exercise diaries, and definitions of acceptable compliance were too heterogeneous to pool quantitatively.
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS, 2025 | Cost-effective alternative to supervised therapy |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Home (self-managed) exercise v. Supervised Therapy
Pain
Disability
Function
Relevant Clinical Info
Littlewood C, Bateman M, Brown K, Bury J, Mawson S, May S, et al. A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study). Clin Rehabil. 2016;30(7):686-696. doi: 10.1177/0269215515593784.
Littlewood et al. (2016) was a multicentre pragmatic RCT included in this meta-analysis that evaluated 86 patients with rotator cuff tendinopathy randomized to either a self-managed single resisted exercise program or usual supervised outpatient physiotherapy. The intervention utilized a symptom-guided resistive exercise loading protocol performed independently at home with minimal clinical contact. At both 3-month and 10-month follow-up, self-management demonstrated equivalent clinical improvements in SPADI scores and pain compared to conventional supervised therapy, serving as a landmark trial demonstrating that minimal-contact, patient-led resistance programs achieve non-inferior outcomes in chronic rotator cuff-related shoulder pain.
Participant Information
of participants
were Female
The sample size was 475
Mean age of 51.5 years.
There were 12 studies used.
