Exercise Application in the Treatment of Patients With Subacromial Pain Syndrome

Not Applicable

Completed

• Conditions: Shoulder Impingement Syndrome
• Interventions: Other: Scapula-focused exercises; Other: Motor control exercises

• Registration Number: NCT02695524
• Lead Sponsor: University of Sao Paulo

Brief Summary

This study evaluate the effectiveness of adding neuromuscular exercises with tactile, visual and auditory feedback to a scapula-focused treatment, both emphasizing the periscapular muscles on improvement of disability in patients with subacromial pain syndrome compared to patients receiving only strengthening exercise protocol.

Detailed Description

Evidence of the effectiveness conservative treatments in shoulder impingement are in favor the application of specific exercises for scapulothoracic muscles and rotator cuff on pain reduction and improvement of upper limb function, supervised or performed at home, and these same exercises associated with other therapies promote a greater reduction in pain and improvement in disability.

Currently, the evidence of better methodological quality present in the literature13 points out that the performance of motor control exercises focused on the scapula associated with mobilization and stretching generate pain improvement and clinically relevant improvement of the function. The few studies in this area have great methodological diversity with significant limitations. The hypothesis is that patients with subacromial pain syndrome who will receive traditional exercise protocol with the addition of neuromuscular training will show less functional disability, a greater reduction in pain intensity, increase muscle strength and range of motion when compared to the patient group that will receive only the protocol without neuromuscular training, immediately after the intervention, four and eight weeks and four months after randomization and that these benefits are clinically relevant.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2016-02-19
• Study First Submitted QC: 2016-02-24
• Study Start: 2016-03
• Study First Posted: 2016-03-01
• Primary Completion: 2017-07
• Study Completion: 2017-08
• Results First Submitted: 2018-12-17
• Status Verified: 2019-08
• Results First Submitted QC: 2019-08-15
• Last Update Submitted: 2019-08-15
• Results First Posted: 2019-08-19
• Last Update Posted: 2019-08-19

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Diagnosis of subacromial pain syndrome with confirmed positivity in at least three of the five specific orthopedic impact tests: Neer test, Hawkins- Kennedy test, painful arc, external rotation resistance and empty can. Present history of pain in the shoulder lasting more than a week located in the proximal area of the shoulder

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Exclusion Criteria

• Subjects with a history of trauma or shoulder surgery, total rupture of the rotator cuff tendon and biceps, physically active involving the upper limbs or considered active accordance with the short version International Physical Activity Questionnaire (IPAQ). Subjects who have neurological diseases, referred pain in arms (indicative of involvement in the cervical or thoracic region), systemic disease involving the joints such as rheumatoid arthritis or fibromyalgia, the presence of disorders in the wrist such as carpal tunnel syndrome, and have done physical therapy in the shoulder the last six months.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Scapula-focused exercises	Scapula-focused exercises	Side lying external rotation, prone horizontal abduction , Scapular punch, Knee Push, Full can, D1 Diagonal, three times a week, 8 weeks, 3x10 repetitions
Motor control exercises	Scapula-focused exercises	Towel slide, Scapular Clock, PNF scapular, Inferior Glide modified, Scapular Orientation Exercise, protraction and retraction of scapula, three times a week, 8 weeks, 3x10 repetitions
Motor control exercises	Motor control exercises	Towel slide, Scapular Clock, PNF scapular, Inferior Glide modified, Scapular Orientation Exercise, protraction and retraction of scapula, three times a week, 8 weeks, 3x10 repetitions

Primary Outcome Measures

Name	Time	Method
Change in Functionality Evaluated With Specific Questionnaire	baseline, four and eight weeks and sixteen weeks after randomization	The Brazilian version of Shoulder Pain and Disability Index ranging 0 to 100 points. Lower scores indicate better functionality

Secondary Outcome Measures

Name	Time	Method
Change in Intensity of Pain Evaluated by a Scale	baseline, four and eight weeks and sixteen weeks after randomization	Pain Numerical Rating Scale from 0 to 10. Lower values indicate improvement in pain
Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees	baseline, four and eight weeks and sixteen weeks after randomization	abduction, adduction, internal and external rotation of the shoulder
Satisfaction With Treatment Evaluated With Specific Questionnaire	four, eight weeks and sixteen weeks after randomization	Medrisk Questionnaire ranging 13 to 80 points. High scores indicate satisfaction with treatment
Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees	baseline, four and eight weeks and sixteen weeks after randomization	upward rotation and tilt of the scapula
Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF)	baseline, four and eight weeks and sixteen weeks after randomization	Strength of serratus anterior, trapezius muscles, abduction, adduction, internal and external rotation movements the arm with hand held Dynamometer.
Perceived Change Evaluated by Numerical Scale	four, eight weeks and sixteen weeks of randomization	Global Perceived Effect Scale ranging -5 to +5 points. Positive values indicate improvement and negative values indicate worsening of symptoms
Change in Kinesiophobia Evaluated With Specific Questionnaire	baseline, four and eight weeks and sixteen weeks after randomization	Tampa Scale of Kinesiophobia ranging 17 to 68 points. High scores indicate high degree kinesiophobia

Trial Locations

Locations (1)

University of São Paulo, Ribeirão Preto Medical School; 🇧🇷 Ribeirão Preto, São Paulo, Brazil