Effect of Exercise-Based Interventions on Pain, Function, Global Perception of Change and Quality of Life of Individuals with Gluteal Tendinopathy: Systematic Review of Randomized Controlled Trials including GRADE Recommendations
Tendon. Tendonitis. Greater trochanter pain syndrome. Trochanteric bursitis. Hip.
Therapeutic exercises have been shown to be effective for the treatment of tendinopathies, however, the effects of exercise for the treatment of gluteal tendinopathy have not yet been systematically reviewed. The aim of this review was to evaluate the effect of exercise on pain intensity, function, global perception of change and quality of life in individuals with gluteal tendinopathy. Searches for randomized or quasi-randomised controlled trials verifying the efficacy of exercise for gluteal tendinopathy were performed in the Cochrane Library, MEDLINE/PubMed, CINAHL, Embase, and PEDro. The selection of articles, data extraction and assessment of the methodological quality of the studies were carried out by two researchers independently, with disagreements resolved by a third researcher. Results were summarized as mean differences and 95% confidence intervals. The quality of evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. Eight studies fulfilled the inclusion criteria and were included for analysis. The results suggest that exercise is superior to the wait-and-see approach in terms of pain, function, overall perception of change, and short- and long-term quality of life. There was no difference between isometric and isotonic exercise in pain, function, quality of life, or short-term treatment success rate. Exercise plus education is superior to corticosteroid infiltration (CI) for short-, medium-, and long-term treatment success rate. Exercise is superior to platelet-rich plasma (PRP) infiltration for pain in the short- and long-term. Finally, there was no difference between exercise and sham exercise in terms of pain, function, global perception of change, and quality of life in short- and long-term. In conclusion, exercises have better results than approaches such as 'wait and see' and injections of CI or PRP for the treatment of gluteal tendinopathy. However, treatment effect estimates have only low to very low certainty evidence to support them, and more high-quality controlled trials are needed to further clarify the matter.