Exercise Application in the Treatment of Patients With Subacromial Pain Syndrome

Study Overview
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Brief Summary
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This study evaluate the effectiveness of adding neuromuscular exercises with tactile, visual and auditory feedback to a scapula-focused treatment, both emphasizing the periscapular muscles on improvement of disability in patients with subacromial pain syndrome compared to patients receiving only strengthening exercise protocol.

Detailed Description
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Evidence of the effectiveness conservative treatments in shoulder impingement are in favor the application of specific exercises for scapulothoracic muscles and rotator cuff on pain reduction and improvement of upper limb function, supervised or performed at home, and these same exercises associated with other therapies promote a greater reduction in pain and improvement in disability. Currently, the evidence of better methodological quality present in the literature13 points out that the performance of motor control exercises focused on the scapula associated with mobilization and stretching generate pain improvement and clinically relevant improvement of the function. The few studies in this area have great methodological diversity with significant limitations. The hypothesis is that patients with subacromial pain syndrome who will receive traditional exercise protocol with the addition of neuromuscular training will show less functional disability, a greater reduction in pain intensity, increase muscle strength and range of motion when compared to the patient group that will receive only the protocol without neuromuscular training, immediately after the intervention, four and eight weeks and four months after randomization and that these benefits are clinically relevant.

Official Title
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Effect of Scapula-focused Treatment With Additional Motor Control Exercises on Pain and Disability in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial

Conditions
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Shoulder Impingement Syndrome

Intervention / Treatment
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* Other: Scapula-focused exercises
* Other: Motor control exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of subacromial pain syndrome with confirmed positivity in at least three of the five specific orthopedic impact tests: Neer test, Hawkins- Kennedy test, painful arc, external rotation resistance and empty can. Present history of pain in the shoulder lasting more than a week located in the proximal area of the shoulder Exclusion Criteria: Subjects with a history of trauma or shoulder surgery, total rupture of the rotator cuff tendon and biceps, physically active involving the upper limbs or considered active accordance with the short version International Physical Activity Questionnaire (IPAQ). Subjects who have neurological diseases, referred pain in arms (indicative of involvement in the cervical or thoracic region), systemic disease involving the joints such as rheumatoid arthritis or fibromyalgia, the presence of disorders in the wrist such as carpal tunnel syndrome, and have done physical therapy in the shoulder the last six months.

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 |
| --- | --- |
| Active Comparator: Scapula-focused exercises<br>Side lying external rotation, prone horizontal abduction , Scapular punch, Knee Push, Full can, D1 Diagonal, three times a week, 8 weeks, 3x10 repetitions | Other: Scapula-focused exercises<br> <br> |
| Experimental: Motor control exercises<br>Towel slide, Scapular Clock, PNF scapular, Inferior Glide modified, Scapular Orientation Exercise, protraction and retraction of scapula, three times a week, 8 weeks, 3x10 repetitions | Other: Scapula-focused exercises<br> <br> Other: Motor control exercises<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Functionality Evaluated With Specific Questionnaire | The Brazilian version of Shoulder Pain and Disability Index ranging 0 to 100 points. Lower scores indicate better functionality | baseline, four and eight weeks and sixteen weeks after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Intensity of Pain Evaluated by a Scale | Pain Numerical Rating Scale from 0 to 10. Lower values indicate improvement in pain | baseline, four and eight weeks and sixteen weeks after randomization | 
| Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Strength of serratus anterior, trapezius muscles, abduction, adduction, internal and external rotation movements the arm with hand held Dynamometer. | baseline, four and eight weeks and sixteen weeks after randomization | 
| Perceived Change Evaluated by Numerical Scale | Global Perceived Effect Scale ranging -5 to +5 points. Positive values indicate improvement and negative values indicate worsening of symptoms | four, eight weeks and sixteen weeks of randomization | 
| Change in Kinesiophobia Evaluated With Specific Questionnaire | Tampa Scale of Kinesiophobia ranging 17 to 68 points. High scores indicate high degree kinesiophobia | baseline, four and eight weeks and sixteen weeks after randomization | 
| Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | abduction, adduction, internal and external rotation of the shoulder | baseline, four and eight weeks and sixteen weeks after randomization | 
| Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk Questionnaire ranging 13 to 80 points. High scores indicate satisfaction with treatment | four, eight weeks and sixteen weeks after randomization | 
| Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | upward rotation and tilt of the scapula | baseline, four and eight weeks and sixteen weeks after randomization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Shoulder