BESS Patient Care Pathway: Subacromial Pain

This article provides summary guidance for the management of Subacromial Pain using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) of rating quality of literature and grading the strength of available evidence. The Guideline development group of volunteers including orthopaedic surgeons, trainees, physiotherapists and patients set out explicit PICO questions, to specify all important outcomes to determine the clinical effectiveness of common treatment options for Subacromial Shoulder Pain compared with no treatment or placebo. A clinical librarian performed a search (date 6 December 2023) for available systematic reviews and randomised controlled trials (RCTs) from January 2013 onwards, and evidence was collected and summarised using explicit GRADE criteria for rating the quality of evidence. A total of 6261 records (3686 MEDLINE, 2543 Cochrane CENTRAL and 32 Cochrane CDSR) were retrieved by the searches. The results of the databases were deduplicated in EndNote 21, leaving a total of 5283 unique records. These were narrowed down to 342 articles (242 RCTs and systemic reviews) after excluding articles on other causes of shoulder pain. Recommendations were characterised as strong or weak according to the quality of the supporting evidence. This informative summary provides the quality of available evidence for management of Subacromial Pain.