Exercise in the Physiotherapy Management of Shoulder Impingement

Study Overview
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Brief Summary
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The purpose of this trial is to investigate the effectiveness of an evidence based exercise program for shoulder impingement. Approximately 1% of adults consult their General Practitioner (GP) with shoulder pain each year, making it the third most common reason for musculoskeletal GP consultations in the UK. A further 50% of these patients are diagnosed with subacromial impingement syndrome (SAIS) (shoulder impingement syndrome) and commonly referred for physiotherapy treatment. This trial aims to compare the effectiveness of an evidence based exercise protocol with usual physiotherapy care.

Detailed Description
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Physiotherapy management of shoulder impingement frequently involves exercise, however there is little evidence underpinning exercise prescription and outcomes are poor. Few trials have investigated which muscles should be targeted and how they should be strengthened with respect to the mode, frequency, duration, intensity and progression. This is a randomized controlled trial(RCT) investigating the effectiveness of an evidence based exercise program for shoulder impingement. This research may have an impact on how physiotherapists provide exercise programs to patients with shoulder impingement.

Official Title
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The Effectiveness of Exercise in the Physiotherapy Management of Subacromial Impingement Syndrome

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Evidence based exercise protocol
* Other: Usual physiotherapy without exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients must be aged 18 years and older. Shoulder pain of at least 3/10 in severity that has been diagnosed by a consultant rheumatologist, orthopaedic surgeon or general practitioner within the past 12 months. Positive Hawkins-Kennedy test. Positive on testing either supraspinatus (empty can test) or infraspinatus (resisted external rotation in neutral). Exclusion Criteria: Acute traumatic conditions. Evidence of rotator cuff tear (positive drop arm test) or any other shoulder joint pathology (e.g. adhesive capsulitis, labral tears). A history of fractures of the upper arm, shoulder or clavicle within the past two years. A history of dislocation of the shoulder within the previous two years. Postoperative conditions involving the upper arm, shoulder or clavicle. Inflammatory or systemic diseases. Current signs and symptoms of acute nerve root pain arising from the cervical or upper thoracic spine. Previous physiotherapy for the same condition involving an exercise regime. Previous corticosteroid injection of the affected shoulder within the past 6 months. Unwilling participant.

Ages Eligible for Study
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Minimum Age: 18 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual physiotherapy without exercise<br>Will receive 6 sessions of modified usual physiotherapy care that can consist of any physiotherapeutic modalities normally provided except exercise. this may consist of postural advice, taping, electrotherapy, acupuncture, manual joint mobilizations of the shoulder, cervical or thoracic spine. | Other: Usual physiotherapy without exercise<br>* Will receive modified usual physiotherapy care that can consist of any physiotherapeutic modalities normally provided except exercise. this may consist of postural advice, taping, electrotherapy, acupuncture, manual joint mobilizations of the shoulder, cervical or thoracic spine.<br>* Other names: Usual care;|
| Experimental: Exercise<br>Will receive an evidence based exercise protocol but no other physiotherapeutic modalities | Other: Evidence based exercise protocol<br>* An evidence based graduated exercise rehabilitation protocol will be provided and supervised by a physiotherapist. patients will receive 6 sessions of supervised physiotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change from baseline in average pain scores at rest and at night using 100mm visual analogue scale (VAS). | Primary outcome measure: Average pain scores at rest and at night for the week prior to measurement will be recorded using a 100mm visual analogue scale (VAS). The change in pain scores at 6 and 12 weeks from baseline will be measured. | Outcomes measured at 0, 6 and 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Western Ontario Rotator Cuff Index (WORC | Secondary outcome measures will focus on function, disability and quality of life, consisting of a combination of generic, region specific and disease-specific health questionnaires. The change in scores from baseline will be measured. | 0, 6 and 12 weeks | 
| The American Shoulder and Elbow Surgeons function score. | Limb specific outcome measure | 0. 6 and 12 weeks | 
| SF-36 Health Survey • SF-36 Health Survey | Generic measure of health status | 0, 6 and 12 weeks | 
| Isometric strength and range of movement of shoulder flexion, abduction, external rotation and internal rotation using a hand held dynamometer. | objective measures of strength and ROM | 0, 6 and 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Subacromial impingement syndrome, Rotator cuff, Exercise, Physiotherapy