Effect of home exercise programs in patients with non-tears rotator cuff-related shoulder pain: a systematic review and meta-analysis.

introductionConservative treatment based on physiotherapy is the first option for non-tears rotator cuff related shoulder pain (RCSP). Although several studies demonstrate the positive effect of therapeutic exercise, aspects such as the influence of supervised exercises versus home-self training or the level of adherence are still unclear. The objective is to study the effect of home exercise programs compared to supervised exercise, either alone or combined with standard physiotherapy treatment. EVIDENCE ACQUISITION: Web of Science, PubMed, SCOPUS, EMBASE, trials registries and reference lists with relevant articles were searched up to March 2025. Only randomized controlled trials were included that aimed to compare the effect of a home exercise program in patients versus supervised exercise, either in isolation or with usual physiotherapy. The PEDro scale and the Cochrane Collaboration tool were used to evaluate the quality of the studies and the risk of bias, respectively. Exercise Interventions Content Assessment, using the proforma provided in the CERT, and adherence were extracted from the included manuscripts. Data were extracted by two independent assessors using a standardized form. Meta-analyses were conducted with the R statistical program using fixed or random effects models according to the heterogeneity assessed with I EVIDENCE SYNTHESIS: Twelve RCTs (N.=475) were included. Home self-training was similar and no differences were found at 12 weeks from supervised exercise program, either alone or combined with standard physiotherapy treatment on Visual Analogic Scale (VAS) (SMD, 0.92; 95% CI, 0.58 to 1.26, P=0.66); Constant-Murley Score (CS) (SMD, -0.82; 95% CI, -1.05 to -0-60, P=0.64); and Shoulder Pain and Disability Index (SPADI) (SMD, 1; 95% CI, 0.74 to 1.26, P=0.93). It was impossible to include adherence in the meta-analysis due to the small number of studies reporting this data and the heterogeneity of the criteria for accepting adequate adherence to the prescribed exercise program.

conclusionsHome self-training might be equally effective as outpatient and supervised exercise, isolated or combined with the usual physiotherapy, in terms of primary outcomes. However, the lack of information on adherence rates, the content of the exercise or how it is performed is worrying. Furthermore, the heterogeneity of the criteria related to treatment adherence and compliance indicates that more literature is needed to relate the effect produced with the type of exercise and therapeutic adherence.