Scapular Movement Training Versus General Exercises for Individuals With Shoulder Pain

Study Overview
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Brief Summary
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Interventions focused on the scapula have been frequently used to treat shoulder pain. However, most studies do not assess the contribution of scapular movement alteration for the symptoms. Objectives: To compare the effects of two interventions for shoulder pain: Scapular Movement Training and General Exercises.

Detailed Description
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This is a double-blinded randomized controlled trial. Sixty-four subjects with shoulder pain, scapular dyskinesis, and positive scapular assistance test will be randomized in two groups: 1) Scapular Movement Training, and 2) General Exercises. The Scapular Movement Training Group will receive the orientation about proper scapular position and movement, and will be trained to modify the scapular movement pattern. The General Exercises Group will perform scapulothoracic stretching and strengthening exercises. Both groups will be treated twice a week for eight weeks. The following outcomes will be collected at baseline and follow-up: scapular kinematics, electromyographic muscle activity of the upper, middle and lower trapezius, and serratus anterior, as well as pain intensity, function, and fear avoidance beliefs. Also, pain intensity, function, and fear-avoidance beliefs will be assessed at the fourth week of follow-up after the end of treatment's period.

Official Title
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Scapular Movement Training Versus General Exercises for Individuals With Shoulder Pain: Randomized Controlled Trial

Conditions
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Shoulder Pain, Musculoskeletal Disease, Joint Disease, Shoulder Injury

Intervention / Treatment
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* Other: Scapular Movement Training
* Other: General Exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Shoulder pain intensity ≥ 3 points on Numerical Rating Scale; Shoulder pain lasting ≥ 3 months; Scapular dyskinesis; Positive Scapular Assistance Test; Arm elevation ≥ 150°; Exclusion Criteria: Body Mass index > 28Kg/m History of humerus, clavicle and scapula fracture and/or surgery; History of rotator cuff surgery or tears, shoulder dislocation, and instability; Frozen Shoulder; Neurological or systemic disease which may alter the muscle strength and sensibility; Positive Upper Limb Tension Test and/or Spurling's test Pregnancy; Physical therapy within 6 months; Corticosteroid injection within 3 months Transpore tape allergy;

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Scapular Movement Training<br>Orientation and scapular exercises, performed twice a week, for 8 weeks. | Other: Scapular Movement Training<br>* Orientation about the proper scapular position and movement and training to modify the scapular movement pattern.<br>* Other names: Orientation and training;|
| Active Comparator: General Exercises<br>Scapulothoracic muscle stretching and strengthening exercises, performed twice a week, for 8 weeks. | Other: General Exercises<br>* Strengthening and stretching exercises.<br>* Other names: Exercises;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Three-Dimensional Scapular Kinematics from baseline to 8 weeks. | 3-D Scapular kinematics (upward/downward rotation; internal/external rotation; anterior/posterior tilt) will be measured by an electromagnetic tracking system (in degrees). | Pre (baseline) and post Treatment (8 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Muscle activity from baseline to 8 weeks. | Surface electromyographic recorded from scapulothoracic muscles (Upper trapezius, Middle Trapezius, Lower Trapezius and Serratus Anterior). | Pre (baseline) and post Treatment (8 weeks) | 
| Change in Pain from baseline to follow-up. | The pain will be measured with 11 point - Numerical Rating Pain Scale with scores ranging from 0 (no pain) to 10 (maximum pain). | Pre (baseline), 4 weeks, post Treatment (8 weeks), and follow-up (4 weeks after treatment ) | 
| Change in Function from baseline to follow-up. | The Function will be measured with Disabilities of the Arm, Shoulder and Hand with scores ranging from 0 to 100 (higher score reflects greater disability). | Pre (baseline), 4 weeks, post Treatment (8 weeks), and follow-up (4 weeks after treatment ) | 
| Change in Fear-Avoidance Beliefs from baseline to follow-up. | The Fear-Avoidance Beliefs Questionnaire (FABQ) contains 2 scales: FABQ work scale (with range from 0 to 42) and FABQ physical activity scale (with range from 0 to 24). Higher scores indicate higher levels of fear-avoidance beliefs. | Pre (baseline), 4 weeks, post Treatment (8 weeks), and follow-up (4 weeks after treatment ) | 
| Change in Overall improvement of Symptoms from baseline to follow-up. | The Overall improvement of Symptoms will be measured with the Global Rating of Change Scale with scores ranging from -7 to +7 (A higher score indicates higher recovery from the condition). | Pre (baseline), 4 weeks, post Treatment (8 weeks), and follow-up (4 weeks after treatment ) | 
| Change in Kinesiophobia from baseline to follow-up | The Kinesiophobia will be measured with Tampa Scale of Kinesiophobia (TKS) with scores ranging from 17 to 68. Higher scores indicate higher degree of kinesiophobia. | Pre (baseline), 4 weeks, post Treatment (8 weeks), and follow-up (4 weeks after treatment ) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Scapula, Physical Therapy, Movement, Rehabilitation