In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .
Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis.
OBJECTIVE To perform a cost-effectiveness analysis of subacromial corticosteroid injection combined with exercise compared with exercise alone in patients with moderate to severe shoulder pain from subacromial impingement syndrome . METHODS A within-trial cost-effectiveness analysis with 232 patients r and omized to physiotherapy-led injection combined with exercise ( n = 115 ) or exercise alone ( n = 117 ) . The analysis was from a health care perspective with 24-week follow-up . Re source use information was collected from all patients on interventions , medication , primary and secondary care contacts , private health care use and over-the-counter purchases . The measure of outcome was quality -adjusted life years ( QALYs ) , calculated from EQ-5D responses at baseline and three further time points . An incremental cost-effectiveness analysis was conducted . RESULTS Mean per patient NHS costs ( £ 255 vs £ 297 ) and overall health care costs ( £ 261 vs £ 318 ) were lower in the injection plus exercise arm , but this difference was not statistically significant . Total QALYs gained were very similar in the two trial arms ( 0.3514 vs 0.3494 QALYs ) , although slightly higher in the injection plus exercise arm , indicating that injection plus exercise may be the dominant treatment option . At a willingness to pay of £ 20,000 per additional QALY gained , there was a 61 % probability that injection plus exercise was the most cost-effective option . CONCLUSION Injection plus exercise delivered by therapists may be a cost-effective use of re sources compared with exercise alone and lead to lower health care costs and less time off work . TRIAL REGISTRATION International St and ard R and omised Controlled Trial Number Register , http://www.controlled-trials.com/is rct n/ , IS RCT 25817033
In many instances , no or minimal attempts to screen were undertaken or reported .
Background Subacromial shoulder pain is a common clinical presentation with much diagnostic uncertainty .
Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to subacromial shoulder pain .
Currently , there is no accepted method of screening of the cervical spine in the presence of subacromial shoulder pain , which risks patients receiving misguided and /or ineffective interventions .
Objective To evaluate approaches used to screen the cervical spine in patients with subacromial shoulder pain .