Efeito de intervenções baseadas em exercícios na dor, função, percepção global de mudança e qualidade de vida de indivíduos com tendinopatia glútea: revisão sistemática incluindo recomendações grade

Abstract

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 objective 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. The searches were performed until March 2021 in the Cochrane Library, MEDLINE/PubMed, CINAHL, Embase and PEDro databases. Randomized or quasirandomized clinical trials involving exercise-based interventions for gluteal tendinopathy were included. Two independent researchers carried out the selection of articles, data extraction and assessment of the methodological quality of the studies, and a third researcher resolved disagreements. The certainty of Evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. Results were summarized as mean differences and 95% confidence intervals according to the outcome of interest, group comparisons and follow-up. Five studies were included with a total sample of 747 patients. The results suggest that exercise is superior to the “wait and see” approach in terms of pain, function, general 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 and education are superior to corticosteroid infiltration (CI) for short, medium, and long term treatment success rate. Finally, there was no difference between exercise and simulated exercise in terms of pain, function, overall perception of change, and short- and long-term quality of life. These findings were based on low to very low quality levels of evidence as assessed by GRADE. We conclude that exercise has better results than 'wait and see', or IC 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.