Effects of Percussion Massage Therapy and Instrument-Assisted Soft Tissue Mobilization on Proprioception, Pain, Disability, and Quality of Life in Individuals With Subacromial Impingement Syndrome: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 48
- 试验地点
- 1
- 主要终点
- Change in Shoulder Joint Position Sense Error
研究概览
简要总结
This assessor-blinded, three-arm, parallel-group randomized controlled trial investigated the additional effects of percussion massage therapy and instrument-assisted soft tissue mobilization in individuals with subacromial impingement syndrome. Forty-eight participants aged 40-60 years with clinically and magnetic resonance imaging-confirmed subacromial impingement syndrome were randomly allocated in a 1:1:1 ratio to conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
All groups received a standardized four-week conventional physiotherapy programme. Participants in the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received their respective interventions three times per week for four weeks. Outcomes were evaluated at baseline and immediately after the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes were shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
详细描述
Subacromial impingement syndrome is commonly associated with shoulder pain, limitations in range of motion, functional disability, and impaired sensorimotor control. Exercise-based rehabilitation is considered a primary component of conservative management. Percussion massage therapy and instrument-assisted soft tissue mobilization are frequently used as adjunct soft-tissue interventions; however, comparative evidence regarding their additional effects in individuals with subacromial impingement syndrome remains limited.
This study was designed as a parallel-group, assessor-blinded randomized controlled trial with a 1:1:1 allocation ratio. Forty-eight eligible participants were randomly allocated to one of three groups: conventional physiotherapy, percussion massage therapy plus conventional physiotherapy, or instrument-assisted soft tissue mobilization plus conventional physiotherapy.
The randomization sequence was computer-generated using Randomizer.org by an independent researcher who was not involved in participant recruitment, intervention delivery, or outcome assessment. Because of the nature of the interventions, participants and treating physiotherapists could not be blinded. Outcome assessments were conducted by an independent physiotherapist blinded to group allocation. Statistical analyses were conducted by a biostatistician blinded to coded group assignments.
All participants received a standardized conventional physiotherapy programme for four weeks. Participants assigned to the percussion massage therapy and instrument-assisted soft tissue mobilization groups additionally received the corresponding soft-tissue intervention three times per week for four weeks.
Outcome assessments were performed at baseline and immediately after completion of the four-week intervention. The primary outcome was shoulder joint position sense during flexion and abduction. Secondary outcomes included shoulder range of motion, resting and activity-related pain, upper-extremity disability, and rotator cuff-related quality of life.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Because of the nature of the interventions, participants and treating physiotherapists were aware of the allocated intervention. Outcome assessments were conducted by an independent physiotherapist who was blinded to group allocation. Statistical analyses were performed by a biostatistician blinded to coded group assignments.
入排标准
- 年龄范围
- 40 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men or women aged 40 to 60 years.
- •Diagnosis of subacromial impingement syndrome confirmed by clinical examination and -magnetic resonance imaging.
- •Positive Neer test.
- •Positive Hawkins-Kennedy test.
- •Positive painful arc test.
- •Shoulder symptoms persisting for at least one month.
- •Ability and willingness to participate in the assessment and intervention programme.
- •Provision of written informed consent.
排除标准
- •Previous surgery involving the affected upper extremity.
- •Inflammatory joint disease.
- •Shoulder osteoarthritis.
- •Rheumatic disease.
- •Malignant or benign tumour affecting the shoulder region or upper extremity.
- •Open wound or active infection in the shoulder region.
- •Inability to tolerate vibration-based therapy.
- •Inability to comply with the study protocol or intervention programme.
研究组 & 干预措施
Conventional Physiotherapy
Participants received a standardized, supervised conventional physiotherapy programme five sessions per week for four weeks.
干预措施: Conventional Physiotherapy (Other)
Percussion Massage Therapy Plus Conventional Physiotherapy
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received percussion massage therapy three times per week for four weeks.
干预措施: Percussion massage therapy device (Device)
Percussion Massage Therapy Plus Conventional Physiotherapy
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received percussion massage therapy three times per week for four weeks.
干预措施: Conventional Physiotherapy (Other)
IASTM Plus Conventional Physiotherapy
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received instrument-assisted soft tissue mobilization three times per week for four weeks.
干预措施: Instrument-assisted soft tissue mobilization device (Device)
IASTM Plus Conventional Physiotherapy
Participants received the standardized conventional physiotherapy programme for four weeks and additionally received instrument-assisted soft tissue mobilization three times per week for four weeks.
干预措施: Conventional Physiotherapy (Other)
结局指标
主要结局
Change in Shoulder Joint Position Sense Error
时间窗: Baseline and immediately after the 4-week intervention
Shoulder joint position sense was assessed using a digital goniometer at target positions of 60 degrees of shoulder flexion and 60 degrees of shoulder abduction. The affected shoulder was passively positioned at the target angle, and the participant was allowed up to 10 seconds to memorize the position. The arm was then returned to the neutral position, and the participant was asked to actively reproduce the target position with the eyes closed. The absolute angular difference between the target position and the reproduced position was calculated in degrees. Three trials were conducted for flexion and three trials for abduction, and the mean absolute error for each direction was used in the analysis. Lower values indicate greater joint position sense accuracy.
Assessment of Joint Position Sense (Proprioception)
时间窗: 4 week
Joint position sense will be assessed using the Becure Extremity ROM system. Proprioception will be evaluated at 60 degrees of shoulder flexion and shoulder abduction. While standing, each participant will first be asked to lift their arm with eyes open and memorize the arm position at 60 degrees. Then, with eyes closed, the participant will be instructed to raise the arm to the same position previously reached with eyes open. The shoulder angle will be measured while the eyes are closed. The difference between the angles recorded with eyes open and eyes closed will be considered the joint position error. This procedure will be performed for both shoulder flexion and abduction at 60 degrees.
次要结局
- Change in Shoulder Range of Motion(Baseline and immediately after the 4-week intervention)
- Change in Resting and Activity-Related Shoulder Pain(Baseline and immediately after the 4-week intervention)
- Change in Upper-Extremity Disability(Baseline and immediately after the 4-week intervention)
- Change in Rotator Cuff-Related Quality of Life(Baseline and immediately after the 4-week intervention)
- Pain Assessment (Visual Analog Scale - VAS)(4 week)
- Range of motion (ROM)(4 week)
- Functionality (Disabilities of the Arm, Shoulder and Hand Questionnaire - DASH)(4 week)
- Quality of Life (Rotator Cuff Quality of Life Questionnaire - RC-QoL)(4 week)
研究者
Emre DANSUK
Principal Investigator
Medipol University