Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

Thilo O Kromer,Rob A De Bie,Caroline Hg Bastiaenen

doi:10.1186/1471-2474-11-114

Abstract

BackgroundShoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome.Methods/DesignThis randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization.The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks.Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book.DiscussionTo our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol. Using high-quality methodologies, this trial will add evidence to the limited body of knowledge about the effect of physiotherapy in patients with SIS.Trial registrationCurrent Controlled Trials ISRCTN86900354

Highlights

Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability
Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book. To our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol
Outcome measures used in this trial are easy to apply in daily practice. To our knowledge this is the first trial comparing individualized physiotherapy led by a defined decision making process to a standard exercise protocol

Summary

Introduction

Shoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Shoulder complaints are one of the most common musculoskeletal complaints seen by health professionals [1,2,3,4,5] with an incidence of 9.5 per 1000 patients presenting to primary care [6] and varying data for point prevalence (6.9% to 26%) [7]. They can lead to a significant reduction of health [6,8], seem to be recurring in nature and do not necessarily resolve over time [9,10,11,12]. The specific diagnosis of SIS is often based on a thorough history and clinical examination; technical examination methods such as MRI or ultrasonography are often not used in first instance [10], because their diagnostic accuracy is still limited [4247]

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