Effectiveness of Transcranial Electrical Stimulation in the Functional Recovery of Subjects with Subacromial Pain Syndrome: Randomized Clinical Trial.
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Subacromial Pain Syndrome
- Sponsor
- University of Valencia
- Enrollment
- 74
- Locations
- 1
- Primary Endpoint
- Changes in Pain and disability Index (SPADI), spanish version, scale.
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
The goal of this clinical trial is to analyze whether a physiotherapy protocol based on strengthening exercises to the shoulder girdle muscles carried on during anodal transcranial electrical stimulation (a-TES) is more effective on the symptoms and functionality of subjects with subacromial pain syndrome than an isolated strengthening program.
The main questions it aims to answer are:
- Is the strengthening + a-TES protocol effective on functionality?
- Is the strengthening + a-TES protocol effective on quality of life?
- Is the strengthening + a-TES protocol effective on pain?
- Is the strengthening + a-TES protocol effective on muscle strength?
- Is the strengthening + a-TES protocol effective on active range of movement?
- Is the strengthening + a-TES protocol effective on proprioception?
- Is the strengthening + a-TES protocol effective on posture?
- Is the strengthening + a-TES protocol effective on glenohumeral and scapulothoracic kinematics?
Participants will perform an 8 weeks-3 days/week shoulder strengthening protocol for the rotator cuff and scapulothoracic muscles using elastic bands and dumbbells. The rotator cuff exercises will be performed while they receive a-TES using a neoprene helmet with the electrodes placed in the opposite hemisphere to the affected side. The scapulothoracic exercises will be performed without the transcranial stimulation.
The experimental group will receive real a-TES, and will be compared with a control group that will perform the same therapeutic exercises but with placebo a-TES to see the effectiveness of the a-TES on the outcomes cited above.
Detailed Description
The project has obtained the approval of the Ethics Committee of the University of Valencia on June 6, 2023 (Id: UV-INV_ETICA-2701990). The intervention will take place in the laboratories of the Physiotherapy Department of the University of Valencia. All the participants, once they have signed the informed consent and, after being randomly assigned to the EG or the CG, will be evaluated before starting the treatment (T0). A post-intervention evaluation will be carried one day after the end of the 24 sessions (T1), and a follow-up evaluation 3 weeks after the intervention (T2). Subjects with unilateral shoulder pain will be recruited through social media and posters posted in primary care centers, hospitals, and other related locations. The study will be triple blind: participants, evaluators and therapists. In order to monitor the possible adverse effects derived from the application of a-TES, the Bruitoni et al. Adverse Effects Questionnaire will be completed in each session. It is a questionnaire that contains 10 possible side effects (headache, neck pain, scalp pain, tingling, itching, burning, redness of the skin, drowsiness, concentration problems, severe mood change).If any of these symptoms occurred, the stimulation would be stopped and the next day would be tried again. If these effects were repeated, especially the headache or were of severe intensity, the patient would be withdrawn from the investigation. The sample size has been calculated with the formula: n = (2 \* (Zα/2 + Zβ) / d) ² (significance level of 0.05, Zα/2 = 1.96; Zβ =0.84, d= 0.5). Total, n= 64 subjects. In addition, the sample may be increased by 15% in anticipation of possible losses throughout the study (= 10 more subjects). Classic statistical methods will be used to calculate the mean as a measure of central tendency and the standard deviation as a measure of dispersion. Before carrying out the inferential analysis, the normal distribution of the sample will be checked using the Shapiro-Wilk test, homoscedasticity using the Levene test, and sphericity using the Mauchly test. Regarding the inferential analysis, a mixed ANOVA will be used with an intra-subject factor (time), with 4 categories, corresponding to the assessments made; and a between-subjects (group) factor corresponding to the assigned intervention. For post hoc comparisons, the Bonferroni adjustment will be used. In the event that the assumptions are not met, the corresponding non-parametric tests will be applied: Wilcoxon and Mann Whitney, adjusting the type I error. In the event of losses, the intention-to-treat procedure will be used for the statistical analysis of the data. .
Investigators
Marta Aguilar
Principal investigator
University of Valencia
Eligibility Criteria
Inclusion Criteria
- •Age between 18 and 65 years.
- •Duration of pain greater than or equal to 3 months.
- •Presence of 3 or more of the following positive clinical tests:
- •painful arc
- •External rotation test against isometric resistance
- •Neer's test
- •Jobe test or empty can test
- •Hawkins-Kennedy test
Exclusion Criteria
- •Previous shoulder or neck surgery.
- •History of shoulder fracture or dislocation.
- •Medical diagnosis of shoulder osteoarthritis.
- •Adhesive capsulitis
- •Cervicobrachialgia or reproducible shoulder pain with neck movements.
- •Clinical signs of total tear of the rotator cuff.
- •Corticosteroid injection in the previous 6 weeks.
- •Inflammatory disease, autoimmune or rheumatic, systemic (arthritis, lupus, myopathies).
- •Cognitive or behavioral problems that make it impossible to understand and follow the intervention (score less than 24 on the Mini-Mental State Examination Score) (73).
- •Any neurological or neoplastic disease.
Outcomes
Primary Outcomes
Changes in Pain and disability Index (SPADI), spanish version, scale.
Time Frame: Before the intervention, inmediately post intervention (and three months follow up.
Scale for the measurement of Pain and disability related to shoulder disfunction. It contains 13 items, each with a score on a numerical scale from 0 (best) to 10 (worst). It consists of two domains: pain (of 5 items, score between 0-50) and disability (of 8 items, score between 0-80). In each domain the score can be expressed as a percentage. The total score of the scale is obtained as the sum of both domains (0 -100%). A higher score indicates greater pain-related disability.
Changes in Western Ontario Rotator cuff (WORC), spanish version, scale.
Time Frame: Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.
Scale for the measurement of the Quality of life related to shoulder disfunction. It consists of 21 questions, each with a visual analogue scale type response. The questions are grouped into 5 domains or sections: physical symptoms (6 items), sports and recreation (4 items), work (4 items), lifestyle (4 items) and emotions (3 items). Each item is measured on a 100 mm scale (from 0 best to 100 worst). So the worst value is 2100 and the best is 0.
Changes in a Visual Analogic scale, for the measurement of the shoulder intensity of pain
Time Frame: Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.
The intensity of the pain experienced in the affected shoulder at rest, at night and during activity in the last week will be evaluated. For this, a visual analogue scale (VAS) will be used. Subjects will mark pain intensity on a continuous horizontal line 10 cm long, labeled on the left end as "no pain" and on the right as "maximal pain".
Changes in shoulder pain pressure threshold (PPT) in Kg.
Time Frame: Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.
Mechanical sensitivity will be assessed using the Pressure Pain Threshold (PPT), which is defined as the minimum pressure at which the sensation of pressure changes to pain. The PPT will be measured with an analog algometer applied perpendicularly to the skin. The PPT will be evaluated on the affected side on: supraspinatus, infraspinatus, upper trapezius, levator scapulae, middle deltoid, C5-C6 interapophyseal joint and tibialis anterior. Higher PPT values (in Kg) will be interpreted as an improvement in mechanical sensitivity to pain in the tested areas.
Secondary Outcomes
- Changes in head forward posture, shoulder protraction and kiphosis (degrees)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in the mean signal amplitud of primary motor cortex (M1) measured by EEG (µV)(Before and after each of the 24 sessions.)
- Changes in Joint Position sense measured by the laser-pointer assisted angle reproduction (LP-ART), test (degrees).(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in the signal frequency of the scapulothoracic muscles measured by a surface electromiograph (Hz)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in shoulder Muscle strenght measured by a dinamometer (Kg)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in the scapulohumeral rithm (i.e., coordinated movement of the glenohumeral joint and the scapulothoracic joint) measured by al inclinometer (degrees).(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in shoulder Active range of movement measured by goniometry (degrees)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in Subacromial space width measured by ultrasound (milimeters)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)
- Changes in the mean signal amplitude of the scapulothoracic muscles measured by a surface electromiograph (µV)(Before the intervention, inmediately post intervention (at eight weeks) and three months follow up.)