Exercise therapy and biofeedback for shoulder pain syndrome: A meta-analysis of effectiveness on pain, function, and strength

Background Shoulder pain syndrome is a common musculoskeletal disorder that impairs daily function and quality of life. While exercise therapy is widely used, the additional value of biofeedback remains unclear. This meta-analysis evaluates the effectiveness of exercise therapy, with and without biofeedback, on pain, function, and strength in individuals with shoulder pain. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Databases were searched until November 2024, with an updated search in February 2025, yielding no additional studies. Results Thirteen trials met the inclusion criteria. Exercise therapy significantly reduced shoulder pain (SMD: −0.47; 95% CI, −0.83 to −0.11; p = 0.01) and improved shoulder function (SMD: 0.70; 95% CI, 0.13 to 1.28; p = 0.02) compared to controls. However, exercise combined with biofeedback did not produce statistically significant improvements in pain (p = 0.42), function (p = 0.25), or strength (p = 0.52). Considerable heterogeneity was observed, especially among biofeedback trials. Sensitivity analyses revealed inconsistent effects of biofeedback across studies. Conclusion Exercise therapy is effective in reducing pain and enhancing function in individuals with shoulder pain. The addition of biofeedback shows no consistent benefit and requires further high-quality research. Heterogeneity among studies warrants cautious interpretation.