Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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British journal of sports medicine
Comparative effectiveness of physical therapy interventions in adults with rotator cuff tendinopathy: a systematic review and network meta-analysis
OBJECTIVE: To compare the effects of different physical therapy interventions and identify the most effective intervention on pain, function, quality of life (QoL) and adverse events (AEs) in adults with rotator cuff (RC) tendinopathy. DESIGN: Systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs). DATA SOURCES: Seven databases and two trial registries were searched up to March 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: RCTs comparing physical therapy interventions to any other physical therapy intervention, sham, placebo, waiting list or no treatment on pain, function, QoL and AEs in adults with RC tendinopathy. DATA SYNTHESIS: A frequentist NMA using a random-effects model was performed. Risk of bias and certainty of the evidence were assessed using the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively. RESULTS: 89 RCTs (5532 participants) were included. Exercises targeting the shoulder muscles may reduce pain (standardised mean difference (SMD) -0.79, 95% CI -1.33 to -0.26) and improve function (SMD 0.74, 95% CI 0.34 to 1.14) compared with no treatment but the evidence is very uncertain. Exercises targeting shoulder and scapular muscles in addition to percutaneous electrolysis (SMD -1.58, 95% CI -2.68 to -0.48) and to trigger point dry needling (SMD 3.10, 95% CI 1.99 to 4.22) seem to be the most effective interventions on pain and function at the end of treatment, respectively. CONCLUSION: Most of the interventions identified may not be superior to isolated shoulder exercises alone, which might be considered a reasonable first-line approach, but the evidence is very uncertain and most interventions are informed by limited data. High-quality research is needed to improve evidence of physical therapy interventions in adults with RC tendinopathy. PROSPERO REGISTRATION NUMBER: CRD42024527176.
8 July 2026
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Understanding self-management and digital health needs in musicians with playing-related musculoskeletal disorders: an explanatory sequential mixed-methods study
OBJECTIVES: To explore the characteristics of musicians with current or previous troubling musculoskeletal symptoms associated with musician self-limitation of activity (often referred to as playing-related musculoskeletal disorders (PRMSDs)), barriers and facilitators to PRMSD self-management, health needs and perspectives on digital health interventions (DHIs). The purpose of the study was to understand the unique needs of this population to effectively inform future DHIs to support this community. DESIGN: A mixed-methods study comprising an online survey and four online focus groups (2-3 participants per group). Survey data were analysed statistically, and focus group discussions were analysed thematically. SETTING: Online survey and focus groups conducted via Zoom. PARTICIPANTS: UK-based musicians with current or previous PRMSDs. RESULTS: A total of 100 musicians participated in the survey study, and 10 musicians participated in the focus group study. Over a third (38%, n=38) of participants had experienced musculoskeletal symptoms that interfered with their ability to play at their usual level 0-2 times in the last 5 years, 24% (n=24) reported 3-5 episodes, and 38% (n=38) had experienced them more than five times. The majority of participants (67%, n=67) continued playing music while experiencing these symptoms. Several barriers to self-management were identified, including limited music-specific health education during training, financial and time constraints and insufficient accessible resources. Key facilitators and health needs included healthcare professionals who understood musicians' professional demands and performance pressures, personalised instrument-specific health support, peer support from fellow musicians and accessible digital resources including self-assessment tools, automated reminders, health tracking, motivational features, peer support forums and multimedia resources organised by condition or symptom stage. Addressing these needs could enable musicians to better manage their symptoms, maintain playing activity and make informed decisions about when and how to seek help. CONCLUSION: This study reveals unmet health needs in musicians and offers recommendations for designing DHIs that promote musicians' health and well-being. Key design recommendations include personalisation by instrument type, health tracking, peer support and consolidated multimedia resources. These findings can inform both intervention design and policy development to better support this population.
26 June 2026
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