Exercise in the Physiotherapy Management of Shoulder Impingement

Not Applicable

• Conditions: Subacromial Impingement Syndrome
• Interventions: Other: Evidence based exercise protocol; Other: Usual physiotherapy without exercise

• Registration Number: NCT01691157
• Lead Sponsor: University of Ulster

Brief Summary

The purpose of this trial is to investigate the effectiveness of an evidence based exercise program for shoulder impingement. Approximately 1% of adults consult their General Practitioner (GP) with shoulder pain each year, making it the third most common reason for musculoskeletal GP consultations in the UK. A further 50% of these patients are diagnosed with subacromial impingement syndrome (SAIS) (shoulder impingement syndrome) and commonly referred for physiotherapy treatment. This trial aims to compare the effectiveness of an evidence based exercise protocol with usual physiotherapy care.

Detailed Description

Physiotherapy management of shoulder impingement frequently involves exercise, however there is little evidence underpinning exercise prescription and outcomes are poor. Few trials have investigated which muscles should be targeted and how they should be strengthened with respect to the mode, frequency, duration, intensity and progression. This is a randomized controlled trial(RCT) investigating the effectiveness of an evidence based exercise program for shoulder impingement. This research may have an impact on how physiotherapists provide exercise programs to patients with shoulder impingement.

Study Timeline

• Study First Submitted: 2012-08-08
• Study Start: 2012-09
• Study First Submitted QC: 2012-09-19
• Study First Posted: 2012-09-24
• Status Verified: 2012-10
• Last Update Submitted: 2012-10-11
• Last Update Posted: 2012-10-12
• Primary Completion: 2013-05
• Study Completion: 2013-05

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 94

Inclusion Criteria

• Patients must be aged 18 years and older.
• Shoulder pain of at least 3/10 in severity that has been diagnosed by a consultant rheumatologist, orthopaedic surgeon or general practitioner within the past 12 months.
• Positive Hawkins-Kennedy test.
• Positive on testing either supraspinatus (empty can test) or infraspinatus (resisted external rotation in neutral).

Exclusion Criteria

• Acute traumatic conditions.
• Evidence of rotator cuff tear (positive drop arm test) or any other shoulder joint pathology (e.g. adhesive capsulitis, labral tears).
• A history of fractures of the upper arm, shoulder or clavicle within the past two years.
• A history of dislocation of the shoulder within the previous two years.
• Postoperative conditions involving the upper arm, shoulder or clavicle.
• Inflammatory or systemic diseases.
• Current signs and symptoms of acute nerve root pain arising from the cervical or upper thoracic spine.
• Previous physiotherapy for the same condition involving an exercise regime.
• Previous corticosteroid injection of the affected shoulder within the past 6 months.
• Unwilling participant.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Exercise	Evidence based exercise protocol	Will receive an evidence based exercise protocol but no other physiotherapeutic modalities
Usual physiotherapy without exercise	Usual physiotherapy without exercise	Will receive 6 sessions of modified usual physiotherapy care that can consist of any physiotherapeutic modalities normally provided except exercise. this may consist of postural advice, taping, electrotherapy, acupuncture, manual joint mobilizations of the shoulder, cervical or thoracic spine.

Primary Outcome Measures

Name	Time	Method
change from baseline in average pain scores at rest and at night using 100mm visual analogue scale (VAS).	Outcomes measured at 0, 6 and 12 weeks	Primary outcome measure: Average pain scores at rest and at night for the week prior to measurement will be recorded using a 100mm visual analogue scale (VAS). The change in pain scores at 6 and 12 weeks from baseline will be measured.

Secondary Outcome Measures

Name	Time	Method
Western Ontario Rotator Cuff Index (WORC	0, 6 and 12 weeks	Secondary outcome measures will focus on function, disability and quality of life, consisting of a combination of generic, region specific and disease-specific health questionnaires. The change in scores from baseline will be measured.
The American Shoulder and Elbow Surgeons function score.	0. 6 and 12 weeks	Limb specific outcome measure
SF-36 Health Survey • SF-36 Health Survey	0, 6 and 12 weeks	Generic measure of health status
Isometric strength and range of movement of shoulder flexion, abduction, external rotation and internal rotation using a hand held dynamometer.	0, 6 and 12 weeks	objective measures of strength and ROM

Trial Locations

Locations (4)

Robinson Memorial Hospital; 🇬🇧 Ballymoney, N.I, United Kingdom

The Waveney Hospital; 🇬🇧 Ballymena, N.I, United Kingdom

Musgrave Park Hospital; 🇬🇧 Belfast, N.Ireland, United Kingdom

The Fort Centre, Physiotherapy Department; 🇬🇧 Coleraine, N.I, United Kingdom