Addressing Shoulder Weakness in Individuals With Rotator Cuff–Related Shoulder Pain: A Systematic Review With Meta-analysis
Bibliographic record
Abstract
OBJECTIVE: To estimate the effects of rehabilitation interventions on strength in people with rotator cuff–related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Seven databases were searched from inception to April 2024. STUDY SELECTION CRITERIA: Clinical trials or cohort studies reporting the effects of interventions lasting at least 6 weeks on objective strength outcomes in adults with RCRSP were included. Studies were excluded if they involved adults with other shoulder-related pathologies, focused exclusively on rotator cuff tears, or included participants who had undergone shoulder surgery. DATA SYNTHESIS: We grouped strength testing results from individual studies according to the direction of the strength test. Meta-analyses were conducted using standardized within-group mean difference from baseline to primary follow-up for each study intervention arm. RESULTS: Twenty-eight studies were included in the meta-analysis. Rehabilitation interventions had a moderate effect on shoulder external rotation strength (standardized mean difference [SMD], 0.56; 95% confidence interval [CI]: 0.39, 0.74; I 2 = 78%; P < .01) and a small effect on shoulder abduction (SMD, 0.47; 95% CI: 0.32, 0.63; I 2 = 54%; P < .01), internal rotation (SMD, 0.41; 95% CI: 0.30, 0.52; I 2 = 25%; P < .08), flexion (SMD, 0.25; 95% CI: 0.01, 0.49; I 2 = 0%; P = .46), and scaption (SMD, 0.48; 95% CI: 0.27, 0.70; I 2 = 35%; P = .14) strength. Interventions that included strength training or active exercises had small-to-moderate effects on all strength outcomes. Interventions without exercises or strength training had no effects. CONCLUSION: Rehabilitation interventions improved strength in people with RCRSP. Interventions that incorporated active exercises or strength training are recommended to address strength deficits in people with RCRSP. J Orthop Sports Phys Ther 2026;56(2):67-84. Epub 16 December 2025. doi:10.2519/jospt.2025.13445
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.040 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.041 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".