S YS T E M AT I C R E V I E W P R O T O C O L

Effectiveness of exercise interventions to prevent

shoulder injuries in athletes: a systematic review protocol
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Johannes Jacobus Wessel Swart 1  Benita Olivier 1,2

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1
Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, 2The Wits-JBI Centre for
Evidenced-Based Practice: A JBI Affiliated Group, Johannesburg, South Africa

ABSTRACT

Objective: This review will evaluate the effectiveness of exercise intervention versus no intervention or alternate
intervention to prevent shoulder injuries in athletes.
Introduction: Injury-prevention research has proven the effectiveness of exercise in preventing sports injuries in
general and in the lower limb specifically. However, the results have been extrapolated to sport-related shoulder
injuries from limited evidence. Similar reviews have been faced with insufficient high-quality evidence and limited
studies due to restrictive target populations, resulting in reduced generalizability.
Inclusion criteria: Peer-reviewed randomized controlled trials, with adequate control arms, investigating shoulder-
injury events after exercise intervention in athletes, both training or competing in sports, will be included. Studies
with substitute end points for injury events and non-self-propelled athletes, or vehicle-assisted athletes, will be
excluded.
Methods: A comprehensive search of multiple databases will be used to find relevant studies. The databases will be
searched from inception to April 2021, with no language restrictions imposed. Keywords and derivatives of ‘‘sport,’’
‘‘exercise intervention,’’ ‘‘prevention,’’ ‘‘shoulder injury,’’ and ‘‘randomized controlled trials’’ will be used.
Sources will include Academic Search Ultimate (EBSCO), CINAHL Plus (EBSCO), Cochrane Central Register of
Controlled Trials (Wiley), MasterFILE Premier (EBSCO), MEDLINE (PubMed), Physiotherapy Evidence Database (PEDro),
ProQuest Health and Medical Complete and Nursing and Allied Health Source (ProQuest Complete), ScienceDirect
(Elsevier), Scopus (Elsevier), SPORTDiscus (EBSCO), and Web of Science (Clarivate Analytics). Data appraisal,
extraction, and synthesis will follow JBI guidance for systematic reviews of effectiveness.
Systematic review registration number: PROSPERO CRD42020204141
Keywords: exercise interventions; primary prevention; shoulder injury; systematic review
JBI Evid Synth 2021; 19(10):2847–2856.

Introduction swimmers.3 Shoulder injuries can cause significant

hysical activity can significantly and positively
P enhance health, with injury being the only real
adverse effect.1 Upper-limb injuries contribute up to
21.4% of all injuries sustained during practice in a
variety of team sports.2 The repetitive nature of some
sports can result in higher incidences of shoulder
injuries in individual sports, with an incidence of up
to 91% of shoulder injuries occurring in elite
Correspondence: Johannes Jacobus Wessel Swart,
jjwswart@gmail.com
The authors declare no conflict of interest.
DOI: 10.11124/JBIES-20-00465
dysfunction and disability in sports with high recur-
ring upper-limb loads.4 The high loads from excessive
repetitive shoulder rotary movements in sports like
swimming, or the explosive shoulder actions found in
primary throwing sports, can result in injury.5
The incidence of injury to the upper limb is
lower than that of the lower limb, which justifies
the disproportional amount of literature related to
lower-limb injury prevention.6,7 However, this
appears unjustified when comparing the evidence
amassed in preventing a relatively rare condition,
such as an anterior cruciate ligament injury (ACL).
An ACL injury has an incident rate of 2.10 per 10,000
athletic exposures for contact sports and 0.36 per

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10,000 athletic exposures for non-contact sports8;
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even in high-risk sports only one out of 80 athletes
sustain an injury to the ACL.9 The limited research
resources spend on shoulder-injury prevention seems
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unfounded. There exists a clear need for a specific
review on shoulder-injury prevention.10
Adult athletes experience an average burden of
injury of two weeks per season.11 In 45% of
youth athletes, more than a week’s loss of training
is due to injury.12 A resultant 65% reduction in the
achievement of their performance goals occurs in
athletes who sustain more than one injury requiring
a modification of more than 20% of their seasonal
training weeks.11 The impact of an injury on
an athlete produces a physical, psychological,
performance, and financial fallout that requires
management over several seasons.1,7,13 Prevention
is better than cure in breaking the chain reaction that
develops as a sequela of injury.
In order to prevent sporting injuries, contemporary
research trends advocate primary-injury reduction
strategies, such as rule adaptation, neuro-muscular
training, and equipment modification for at-risk
populations, particularly active youths and adoles-
cents.1,7,12,14 These recommendations were developed
from a disproportional lower-limb research focus,6,15
ignoring the unique characteristics of the lower
limb.4,5,10 This intense lower-limb focus is consistently
defended from a utilitarian perspective2 using evidence
of the successful outcomes.16 Nevertheless, the risk
and burden associated with shoulder injuries necessi-
tate a more specific and rigorous investigation.5,10
A preliminary search of PROSPERO, MEDLINE,
the Cochrane Database of Systematic Reviews, and
JBI Evidence Synthesis was conducted and no simi-
lar systematic review on the topic was identified. A
systematic review from 2014 performed an analysis
on which components of exercise-prevention pro-
grams prevented lower-limb injuries.17 Out of the 25
studies included, eight investigated ‘‘all injuries’’;
however, no included study focused on the shoulder
specifically, and very few contained specific upper-
limb exercises. Additional evidence is required to
endorse the generalizability of exercise effectiveness
to reduce shoulder injuries, as inferred in the studies
evaluating ‘‘all injuries.’’
The shoulder was explicitly targeted in a 2018
systematic review.10 This review investigated
shoulder injury risk factors and prevention in
overhead sports. The study limited the inclusion
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J.J.W. Swart and B. Olivier
population to overhead athletes. The primary aim
was to identify and categorize the risk factors for
sustaining shoulder injuries. The secondary objective
was to synthesize the evidence for the prevention of
shoulder injury in overhead athletes. One relevant
study matched the pre-planned inclusion criteria.18
Potential studies investigating or including
shoulder injuries have recently been published for
baseball,19 cricket pace bowlers,20 football,21,22
handball,23,24 tennis,25 and volleyball.26 Relevant
articles can be included from specific sporting codes,
which are regularly excluded due to limitations on
the population or injury method (eg, Australian
football).13 The recent influx of studies provides a
persuasive argument to investigate the feasibility of
producing a systematic review on shoulder injuries
in sport.
High-quality systematic reviews propose
strength training as superior or at least essential
compared to all other components of injury-
prevention programs for injuries in general,
and to the lower limb specifically.9,14,27,28 The
literature on whether or not exercise interventions
can reduce shoulder injuries and, if so, which
specific elements of the program produce the
proposed effect, is unclear.10 Current research
extrapolation has substituted specific investigation
into shoulder-injury prevention, resulting in some
studies reporting diverse findings when interven-
tions are applied.5
This review will have four aims. The main aim
will be to summarize the available evidence on
shoulder-injury prevention in sport. The second
aim will be to provide estimates of acute injury
versus overuse. The third aim will be to describe
and categorize the different types of exercise inter-
ventions found in the injury-prevention programs.
Exercises will be categorized into strength, stretching
and flexibility, mobility, plyometrics, balance and
proprioception, or multiple components.
Furthermore, the final aim will be to describe and
categorize the components of shoulder-exercise-
intervention programs into open kinematic chain
exercises versus closed kinematic chain exercises.
To the authors’ knowledge, no meta-analysis on the
effectiveness of exercise to prevent shoulder injury
exists. Producing a meta-analysis will enable new
and thought-provoking information, furthering
recommendations for prospective studies in the
field.
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Review question
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What is the effectiveness of exercise intervention
versus no intervention or alternate intervention in
the prevention of shoulder injury in athletes?
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Inclusion criteria
Participants
This review will consider all studies that include
human athletes participating in any sports forms,
irrespective of sex, age, ethnicity, setting, geographi-
cal location, or level of skill. Study participants are
typically healthy and free of injury at the start of
injury-prevention studies; however, in order to
investigate acute injury versus overuse (chronic)
data, the inclusion of both injured and uninjured
participants is necessary. An athlete with an overuse
index injury regularly continues to participate and
can partake in exercise interventions to prevent
secondary injuries, which can be either recurring
or subsequent injuries during a season. Non-self-
propelled or vehicle-assisted sports will be excluded
due to the high levels of damage sustained from
collisions. Collision injuries have no bearing on
the biomechanical and neuromuscular adaptations
that exercise intervention is purported to facilitate.
Sport will be defined according to PubMed’s
medical subject headings (MeSH): ‘‘Activities or
games, usually involving physical effort or skill.
Reasons for engagement in sports include pleasure,
competition, or financial reward.’’29(para.5) As
athletes compete in sport, the definition will
provide absolute clarity if the definition of sport
is ambiguous. A summary definition from the
literature is presented for an athlete: An athlete
must train to improve performance and results;
participate actively in competitions while formally
registered; and devote a considerable amount of
time to the endeavor.30
Interventions
This study will consider literature that assesses the
effectiveness of all exercise interventions aimed at
preventing injury to the shoulder. All types of exercise
intervention will be included and grouped primarily
into six categories: i) strength, ii) stretching and
flexibility, iii) mobility, iv) plyometrics, v) balance
and proprioception, or vi) multiple components of
exercise.
An exercise intervention will be included if it
conforms with and corresponds to the definition
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J.J.W. Swart and B. Olivier
of exercise. Exercise will be defined as: ‘‘a potential
disruption to homeostasis by muscle activity that is
either exclusively, or in combination, concentric,
eccentric or isometric.’’31(p.459)
Comparator
This review will consider studies that compare the
intervention to either a pure passive control group
receiving no interventions (eg, regular training, usual
practice, or no additional training) or an active
control arm receiving alternate forms of intervention
(eg, other programs, technique feedback, supple-
mentation, equipment inclusion, or adaptation of
assistive devices).
Outcomes
The primary outcome measure of interest is shoulder
injury or pain, as defined by the authors. Similarly,
the definitions provided for the outcome measures
in each individual study will be applied.10 In circum-
stances where the injury definition is ambiguous, this
study will define an injury according to the definition
of the International Olympic Committee: ‘‘Injury
is tissue damage or other derangement of normal
physical function due to participation in sports,
resulting from the rapid or repetitive transfer of
kinetic energy.’’32(p.374)
The injury rates and relative risk (RR) will be
calculated using the number of injuries, odds ratios
(OR), rate ratios (rr), hazard ratios (HR), and incident
rate ratio (IRR) reported in the studies or calculated
using STATISTICA (Statsoft, Tulsa, OK), based on
raw data provided in the included studies. An injury
of the shoulder area will include injuries of the
rotator cuff, clavicle, scapula, and the proximal biceps
tendon.32 Research in injury prevention regularly
reports injuries in an upper- and lower-extremity
split. A subgroup analysis of upper-extremity injuries
will be performed in addition if the data permits.
Secondary outcomes will include providing acute
versus overuse data (according to each study’s
definition) estimates, if feasible. An overuse injury
is defined as repetitive micro-trauma over multiple
events that may have either a gradual or sudden onset,
while a singular sudden traumatic event results in
acute injuries.32,33 Secondly, the aim will be to
describe and categorize the different types of exercise
interventions found in injury-prevention programs,
mainly: strength, stretching and flexibility, mobility,
plyometrics, balance and proprioception, or multiple
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components of exercise. Thirdly, we will describe
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and categorize the components of the intervention
program’s shoulder-specific exercises into a closed
or open kinematic chain, in order to establish an
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overview of current prevention programs for the
sporting shoulder.
Types of studies
All randomized controlled trials (RCTs) will be
eligible for consideration. Studies measuring con-
trolled clinical outcomes (eg, shoulder strength) will
be excluded. Quasi-experimental studies and obser-
vational studies will only be included in the absence
of RCTs on the subject matter. The decision to
include only RCTs is based on the concern that
studies with a high risk of bias can intensify bias
if pooled rather than reduce it.34
Methods
This protocol has been registered in PROSPERO
(CRD42020204141). JBI methodology will be
followed for conducting a systematic review of effec-
tiveness.35 The design will incorporate the frame-
work as per the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA)
statement.36 Protocol amendments will be dated,
will include an explanation of the alteration, and
will provide a rationale.
Search strategy
A three-step sequential strategy will be used to dis-
cover the relevant studies. The search process will be
designed and implemented to uncover published and
unpublished studies. Firstly, a restricted investigative
search in MEDLINE (PubMed) will be performed
using the keywords ‘‘shoulder injury,’’ ‘‘primary
prevention,’’ and ‘‘exercise intervention.’’ The initial
search will enable the investigation into which text
words and index terms are required to develop
a comprehensive search strategy for MEDLINE
(PubMed).
The literature search will be designed to include
both MeSH terms and text words. Search terms from
similar reviews will be screened to determine the
completeness of the strategy.8,9 The second search
will be expansive and employ all the identified
keywords and index terms contained in a fully devel-
oped search strategy with the adaptations required
by each specific database. The search procedure for
MEDLINE (PubMed) is attached (Appendix I).
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J.J.W. Swart and B. Olivier
Thirdly, the bibliography of critically appraised
articles selected for inclusion will be scrutinized
for further studies.
All databases will be searched from inception to
April 2021, with an updated search to be performed
near the end of the review. All RCTs contained in the
previous reviews will be included if they comply with
the inclusion criteria.10,17,27 The databases to be
searched from inception up until April 2021 include:
CINAHL Complete (EBSCO), Cochrane Central
Register of Controlled Trials (Wiley), MEDLINE
(PubMed), Physiotherapy Evidence Database
(PEDro), ProQuest Health and Medical Complete
and Nursing and Allied Health Source (ProQuest
Complete), ScienceDirect (Elsevier), Scopus (Elsevier),
SPORTDiscus (EBSCO), and Web of Science
(Clarivate Analytics). Source of unpublished studies
and gray literature will include Academic Search
Ultimate (EBSCO) and MasterFILE Premier (EBSCO).
Published and unpublished literature in all
languages will be considered, and the relevant articles
in languages other than English will be translated.
Study selection
Following the search, all identified citations will be
collated and uploaded into EndNote v.9.3 (Clarivate
Analytics, PA, USA) and duplicates removed. Two
independent reviewers will then screen the titles and
the abstracts against the inclusion criteria for the
review. Potentially relevant studies will be retrieved
in full and their citation details imported into the JBI
System for the Unified Management, Assessment
and Review of Information (JBI SUMARI; JBI,
Adelaide, Australia).37
The full text of selected citations will be assessed
in detail against the inclusion criteria by two inde-
pendent reviewers. Reasons for exclusion of full-text
studies that do not meet the inclusion criteria will be
recorded and reported in the systematic review. Any
disagreements between the reviewers at any stage of
the study selection process will be resolved through
discussion or via arbitration by a third reviewer.
The results of the search will be reported in full
in the final systematic review and presented in a
Preferred Reporting Items for Systematic Reviews
and Meta-analyses (PRISMA) flow diagram.36
Assessment of methodological quality
Two independent reviewers will critically appraise
the selected studies. The methodological quality
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will be assessed after inclusion in the review. The
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standardized JBI critical appraisal checklist for
randomized controlled trials will be utilized for
RCTs and the JBI critical appraisal checklist
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for quasi-experimental studies will be used if non-
randomized experimental studies require inclusion.35
If a disagreement arises between the reviewers, a
discussion will be held to resolve the dispute by con-
sensus. If no agreement can be reached, the decision of
a third independent reviewer will be final.
In the case of missing, incomplete, or ambiguous
data, the authors of the study will be contacted by
email for clarification. The results of the critical
appraisal will be reported in narrative form and a
table. All studies, regardless of the results of their
methodological quality, will undergo data extraction
and synthesis.
Data extraction
A two-reviewer, independent data-extraction pro-
cess will be applied, and a table based on the stan-
dardized data extraction tool from JBI SUMARI will
be used. The retrieved data will include the details
relating to population demographics, type of inter-
vention and characteristics, primary and secondary
outcome measures, and the critical appraisal rating
(Appendix II).
In the case of missing, incomplete, or ambiguous
data, the authors of the study will be contacted by
email for clarification. Any disagreements between
the reviewers will be resolved through discussion or
by arbitration of a third reviewer.
Data synthesis
The rationale is to pool quantitative data for a
statistical meta-analysis using JBI SUMARI. If
pooling is not possible, a narrative method will be
applied to represent the data using tables and
graphs. Effect sizes for categorical data will be
reported as RR and continuous data as standardized
mean differences. Relative risk is intuitively
interpreted and enables greater access for a layper-
son, as OR may be challenging to understand.38,39
The confidence intervals will be calculated at 95%
for analysis of the effect sizes.
Sensitivity analysis will be performed to investi-
gate the robustness of the results and the influence
that variances in study design, statistical methods,
and methodology have on the effect estimates.
Analyses will be performed testing the inclusion of
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J.J.W. Swart and B. Olivier
different cluster adjustment methods; performing
synthesis utilizing different statistical models, meth-
ods, and effect measures; and assessing the inclusion
of methodological quality of studies included. The
testing will ascertain if similarity exists regarding the
effect magnitude and direction.
The standard Cochran’s Q and its P value, together
with the x2 statistical assessments, will identify statis-
tical heterogeneity. The I2 and t2 statistical tests
will quantify the heterogeneity. The thresholds for
heterogeneity will be classified as unimportant (0 to
40%), moderate (30% to 60%), substantial (50% to
90%), and considerable (75% to 100%).40 The lower
the P value of the heterogeneity, the more significant
the clinical heterogeneity (keeping in mind that the
P-value’s significance is set at 0.1 due to the statistical
test’s low power).41
The performance of sub-group analysis will be
executed as the broad topic is expected to produce
high levels of inconsistency, requiring the identifica-
tion of the clinical or methodological sources of
heterogeneity.42 Subgroups will enable the compari-
son of the effects in the following pre-planned groups:
shoulder injuries/upper-extremity injuries; acute/
overuse shoulder injuries; shoulder specific/non-
specific programs; upper/lower-extremity-dominant
sports; and RCTs/cluster RCTs. Shoulder-specific
programs are deemed such if the applicable study
provides a statement to that effect or the program
includes four or more shoulder-targeted exercises.
Lower-extremity-dominant sports require the lower
limb for the majority of sport-specific maneuvers
and skills.
Analytical examinations will be done using a
fixed-effect model if there are less than five studies
included and a random-effects model if there are five
or more studies included.39 A funnel plot will be
created in STATA v.16 (StataCorp. 2019, LLC,
Texas) to assess publication bias and tested by funnel
plot asymmetry, where suitable, using the Egger,
Begg, or Harbord statistical tests. A funnel plot will
not be performed for less than 10 studies.39 A
double-data-entry methodology will be utilized to
reduce errors.
Assessing certainty in the findings
The Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) approach
for grading the certainty of evidence will be followed.
A Summary of Findings (SoF) will be created using
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GRADEPro (McMaster University, ON, Canada).43
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The SoF will present the following information where
appropriate: estimates of relative risk with injury
incidence and a ranking of the quality of the evidence
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based on the risk of bias, directness, heterogeneity,
precision, and risk of publication bias of the
review results.
Acknowledgments
This review will contribute to a masters of science
degree through the University of Witwatersrand for
JS. The Faculty of Health Sciences has reviewed the
protocol, and an ethical clearance waiver has been
applied for from the University of the Witwaters-
rand’s Human Research Ethics Committee (HREC).
NM is the second independent reviewer.
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Appendix I: Search strategy

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MEDLINE (PubMed)

Search conducted on 05/02/2021, retrieving 883 results

1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 07/12/2023

Records
Search Query retrieved
#1 ‘‘athlete’’[Text Word] OR ‘‘Competition’’[Text Word] OR ‘‘contest’’[Text Word] OR 1,693,772
‘‘exercis’’[Text Word] OR ‘‘Game’’[Text Word] OR ‘‘Handball’’[Text Word] OR ‘‘javelin
throw’’[Text Word] OR ‘‘Judo’’[Text Word] OR ‘‘Karate’’[Text Word] OR ‘‘kung fu’’[Text
Word] OR ‘‘overhead’’[Text Word] OR ‘‘physical activit’’[Text Word] OR ‘‘physical
exercis’’[Text Word] OR ‘‘pitcher’’[Text Word] OR ‘‘recreation’’[Text Word] OR ‘‘Soft-
ball’’[Text Word] OR ‘‘sport’’[Text Word] OR ‘‘tae kwon do’’[Text Word] OR ‘‘taekwondo’’
[Text Word] OR ‘‘throw’’[Text Word] OR (‘‘Track’’[Text Word] AND ‘‘field’’[Text Word]) OR
‘‘train’’[Text Word] OR ‘‘triathl’’[Text Word] OR ‘‘Workout’’[Text Word] OR ‘‘wres-
tling’’[Text Word] OR ‘‘athletes’’[MeSH Terms] OR ‘‘athletic performance’’[MeSH Terms] OR
‘‘baseball’’[MeSH Terms] OR ‘‘basketball’’[MeSH Terms] OR ‘‘water sports’’[MeSH Terms] OR
‘‘cricket sport’’[MeSH Terms] OR ‘‘exercise’’[MeSH Terms] OR ‘‘exercise movement
techniques’’[MeSH Terms] OR ‘‘track and field’’[MeSH Terms] OR ‘‘football’’[MeSH Terms]
OR ‘‘games, recreational’’[MeSH Terms] OR ‘‘golf’’[MeSH Terms] OR ‘‘gymnastics’’[MeSH
Terms] OR ‘‘hockey’’[MeSH Terms] OR ‘‘water sports’’[MeSH Terms] OR ‘‘martial arts’’[MeSH
Terms] OR ‘‘motion’’[MeSH Terms] OR ‘‘motor activity’’[MeSH Terms] OR ‘‘movement’’
[MeSH Terms] OR ‘‘basketball’’[MeSH Terms] OR ‘‘para athletes’’[MeSH Terms] OR
‘‘exercise’’[MeSH Terms] OR ‘‘physical exertion’’[MeSH Terms] OR ‘‘physical fitness’’[MeSH
Terms] OR ‘‘water sports’’[MeSH Terms] OR ‘‘racquet sports’’[MeSH Terms] OR ‘‘recrea-
tion’’[MeSH Terms] OR ‘‘water sports’’[MeSH Terms] OR ‘‘soccer’’[MeSH Terms] OR
‘‘sports’’[MeSH Terms] OR ‘‘sports for persons with disabilities’’[MeSH Terms] OR ‘‘sports
medicine’’[MeSH Terms] OR ‘‘swimming’’[MeSH Terms] OR ‘‘tennis’’[MeSH Terms] OR
‘‘volleyball’’[MeSH Terms] OR ‘‘water sports’’[MeSH Terms] OR ‘‘wrestling’’[MeSH Terms] OR
‘‘youth sports’’[MeSH Terms]
#2 ‘‘balance exercise’’[Text Word] OR ‘‘calisthenic’’[Text Word] OR ‘‘exercise interven- 819,392
tion’’[Text Word] OR ‘‘Flexibility’’[Text Word] OR ‘‘intervenion’’[Text Word] OR ‘‘isome-
tic’’[Text Word] OR ‘‘isotonic’’[Text Word] OR ‘‘neuromuscular program’’[Text Word] OR
‘‘neuromuscular training’’[Text Word] OR ‘‘NMT’’[Text Word] OR ‘‘range of motion’’[Text
Word] OR ‘‘strength training’’[Text Word] OR ‘‘stretch’’[Text Word] OR ‘‘body weight’’
[MeSH Terms] OR ‘‘circuit based exercise’’[MeSH Terms] OR ‘‘exercise therapy’’[MeSH
Terms] OR ‘‘muscle strength’’[MeSH Terms] OR ‘‘muscle stretching exercises’’[MeSH Terms]
OR ‘‘proprioception’’[MeSH Terms] OR ‘‘range of motion, articular’’[MeSH Terms] OR
‘‘resistance training’’[MeSH Terms] OR ‘‘yoga’’[MeSH Terms]
#3 ‘‘incidence’’[Text Word] OR ‘‘injury rate’’[Text Word] OR ‘‘prehab’’[Text Word] OR 7,763,175
‘‘prevent’’[Text Word] OR ‘‘Prevention’’[Text Word] OR (‘‘Prevention’’[Text Word] AND
‘‘control’’[Text Word]) OR ‘‘prevention program’’[Text Word] OR ‘‘prevention proto-
col’’[Text Word] OR ‘‘Prophylaxis’’[Text Word] OR ‘‘reduc’’[Text Word] OR ‘‘risk’’[Text
Word] OR (‘‘accident prevention’’[MeSH Terms] OR ‘‘incidence’’[MeSH Terms] OR (‘‘preven-
tion and control’’[MeSH Subheading] AND ‘‘prevention and control’’[MeSH Subheading])
OR ‘‘primary prevention’’[MeSH Terms] OR ‘‘program evaluation’’[MeSH Terms] OR ‘‘risk
assessment’’[MeSH Terms] OR ‘‘risk management’’[MeSH Terms]) OR ‘‘risk reduction
behavior’’[MeSH Terms]

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 SYSTEMATIC REVIEW PROTOCOL J.J.W. Swart and B. Olivier

(Continued)
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Records
Search Query retrieved
1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 07/12/2023

#4 ‘‘dislocation’’[Text Word] OR ‘‘fracture’’[Text Word] OR ‘‘Glenohumeral’’[Text Word] OR 6,835,834

‘‘Gleno-humeral’’[Text Word] OR ‘‘injur’’[Text Word] OR ‘‘instab’’[Text Word] OR ‘‘joint
instabilit’’[Text Word] OR ‘‘pain’’[Text Word] OR ‘‘problem’’[Text Word] OR ((‘‘range of
motion, articular’’[MeSH Terms] OR (‘‘range’’[All Fields] AND ‘‘motion’’[All Fields] AND
‘‘articular’’[All Fields]) OR ‘‘articular range of motion’’[All Fields] OR (‘‘range’’[All Fields]
AND ‘‘motion’’[All Fields]) OR ‘‘range of motion’’[All Fields]) AND ‘‘subluxation’’[Text
Word]) OR ‘‘shoulder fracture’’[Text Word] OR ‘‘shoulder impingement syndrome’’[Text
Word] OR ‘‘shoulder injur’’[Text Word] OR ‘‘shoulder pain’’[Text Word] OR ‘‘shoul-
der’’[Text Word] OR ‘‘strain’’[Text Word] OR ‘‘syndrom’’[Text Word] OR ‘‘trauma’’[Text
Word] OR ‘‘upper limb’’[Text Word] OR (‘‘accidents’’[MeSH Terms] OR ‘‘acromioclavicular
joint’’[MeSH Terms] OR ‘‘athletic injuries’’[MeSH Terms] OR ‘‘cumulative trauma disor-
ders’’[MeSH Terms] OR ‘‘fractures, bone’’[MeSH Terms] OR ‘‘fractures, cartilage’’[MeSH
Terms] OR ‘‘joint instability’’[MeSH Terms] OR ‘‘musculoskeletal system’’[MeSH Terms] OR
‘‘pathology’’[MeSH Terms] OR ‘‘rotator cuff’’[MeSH Terms] OR ‘‘rotator cuff injuries’’[MeSH
Terms] OR ‘‘scapula’’[MeSH Terms] OR ‘‘shoulder dislocation’’[MeSH Terms] OR ‘‘shoulder
fractures’’[MeSH Terms] OR ‘‘shoulder impingement syndrome’’[MeSH Terms] OR ‘‘shoulder
injuries’’[MeSH Terms] OR ‘‘shoulder joint’’[MeSH Terms] OR ‘‘shoulder pain’’[MeSH Terms]
OR ‘‘shoulder injuries’’[MeSH Terms] OR ‘‘soft tissue injuries’’[MeSH Terms] OR ‘‘sprains
and strains’’[MeSH Terms] OR ‘‘tendon injuries’’[MeSH Terms] OR ‘‘tendons’’[MeSH Terms]
OR ‘‘upper extremity’’[MeSH Terms]) OR ‘‘wounds and injuries’’[MeSH Terms]
#5 ‘‘collar bone’’[Text Word] OR ‘‘Glenohumeral’’[Text Word] OR ‘‘Gleno-humeral’’[Text Word] 256,787
OR ‘‘shoulder’’[Text Word] OR ‘‘upper limb’’[Text Word] OR ‘‘acromioclavicular join-
t’’[MeSH Terms] OR ‘‘rotator cuff’’[MeSH Terms] OR ‘‘shoulder joint’’[MeSH Terms] OR
‘‘upper extremity’’[MeSH Terms] OR ‘‘clavicle’’[MeSH Terms]
#6 ‘‘randomized controlled trial’’[Text word] OR ‘‘randomised controlled trial’’[Text word] OR 761,572
‘‘randomized clinical trial’’[Text Word] OR ‘‘randomised clinical trial’’[Text Word] OR
‘‘randomized controlled trial’’[Publication Type]
#7 #1 AND #2 AND #3 AND #4 AND #5 AND #6 883
No language or date limits.

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 SYSTEMATIC REVIEW PROTOCOL J.J.W. Swart and B. Olivier

Appendix II: Data extraction instrument

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First author’s last name

1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 07/12/2023

Publication year
Appraisal rating
Country
Setting
 Sport
 Level
Participants
 Sex
 Age
Sample
 Sample size
 Drop-out rate
 Sample analyzed
 ITT/PP analysis
 Cluster adjusted
Intervention
 Name or description
 Type
 Frequency
 Dose
 Compliance
 Categorization
 OKC vs CKC
Outcome measures
 Shoulder or upper extremity
 Number of injuries (INV vs CON)
 Acute versus overuse
 Primary outcome
Bias and main limitations
CKC, closed kinematic chain; CON, control group; INV, intervention group; ITT, intention to treat; OKC, open kinematic chain; PP, per protocol

JBI Evidence Synthesis ß 2021 JBI 2856

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