Training in Subacromial Impingement Syndrome

Study Overview
=================
Brief Summary
-----------------
A randomized controlled trial comparing a comprehensive supervised training regimen with a validated home-based regimen for subacromial impingement syndrome.

Detailed Description
-----------------
The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Randomised control trial with blinded assessor. 126 consecutive patients with subacromial impingement syndrome were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles.

Official Title
-----------------
Comprehensive Supervised Heavy Training Program Versus Home Training Regimen in Patients With Subacromial Impingement Syndrome: a Randomized Trial.

Conditions
-----------------
Subacromial Impingement Syndrome

Intervention / Treatment
-----------------
* Other: Training


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Subacromial impingement syndrome Exclusion Criteria: Ongoing claim with the Labour market insurance, insurance company or comparable institution. Ongoing application for job revalidation or health related pension. Radiating neck pain. Ultrasound verified complete rotator cuff tendon lesion, as defined by hypoechoic or anechoic full thickness defect of the tendon, or absence of the tendon. Periarthritis humeroscapularis. Acute luxation or fracture of the shoulder. Ongoing steady analgetic treatment of other concomitant painful condition, unrelated to the patients shoulder problem.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients were randomized to either a supervised training regimen (STR) or a home training regimen
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Supervised training regimen<br>This training regimen consisted of 3 phases: the 1st focused on restoring motion, the 2nd on strengthening of the rotator cuff muscles, and the 3rd on strengthening of the scapular muscles. Stretching completed every training session. Motion training consisted of 6 exercises. Postural training: shoulder shrugs and shoulder retraction exercises. Glenohumeral training: pendulum exercises, and active assisted flexion, abduction and external rotation. Strengthening of the rotator cuff: side lying external rotation, internal rotation and scaption. Strengthening of the scapular muscles: press-up, push-up with a plus, serratus anterior supine punch, standing rowing (low row), and seated rowing (high row). Training sessions ended with 4 stretches: anterior shoulder stretch, posterior shoulder stretch, inferior capsular stretch, sleepers stretch. Exercises were performed 3 times a week, with progression after the 1st week, and thereafter every 2nd week. | Other: Training<br> <br> |
| Active Comparator: Home training regimen<br>The program consisted of the following: 1 motion exercise: upper trapezius relaxation 3 strengthening exercises: serratus anterior strengthening exercise, humeral external rotation with the arm at the side of the body, and humeral external rotation with a rubber band and the arm at 90 degrees abduction. 2 stretching exercises: posterior shoulder and pectoralis minor stretching, Exercises were performed daily, with weekly progression. | Other: Training<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder constant score | Functional assessment of the shoulder | 6 months after ended training | 
| Shoulder Rating Questionnaire | Self-administered questionnaire | 6 months after ended training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Passive motion | Shoulder flexion, measurement in degrees; Shoulder abduction, measurement in degrees; Shoulder internal rotation, measurement in degrees; Shoulder external rotation, measurement in degrees. | 6 months after ended training | 
| Active motion | Shoulder flexion, measurement in degrees; Shoulder abduction, measurement in degrees; Shoulder internal rotation, measurement in degrees; Shoulder external rotation, measurement in degrees. | 6 months after ended training | 
| Visual Analogue Scale | Measurement of pain on a 10 cm scale, where 0 indicates no pain, and 10 worst pain for the following muscle tests: full can test, empty can test, lift off test, resisted external rotation, palm-up test, Yergason´s test. | 6 months after ended training | 
| Neer test | Stabilization of the patient's scapula with one hand, while passively flexing the arm while it is internally rotated. If the patient reports pain in this position, then the result of the test is considered to be positive (rated positive = 1 and negative = 0). | 6 months after ended training | 
| Hawkins test | Placing the patient's shoulder in 90 degrees of shoulder flexion with the elbow flexed to 90 degrees, and afterwards internally rotating the arm. The test is considered to be positive if the patient experiences pain with internal rotation (rated positive = 1 and negative = 0). | 6 months after ended training | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
shoulder, rotator cuff, exercise