1
|
Wang X, Jia S, Cui J, Xue X, Tian Z. Effect of extracorporeal shock wave combined with autologous platelet-rich plasma injection on rotator cuff calcific tendinitis: study protocol for a randomized controlled trial. Trials 2024; 25:616. [PMID: 39294797 PMCID: PMC11409635 DOI: 10.1186/s13063-024-08407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/16/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Rotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear. METHODS This study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas. DISCUSSION This study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options. TRIAL REGISTRATION ClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1.
Collapse
Affiliation(s)
- Xiaofang Wang
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Shuya Jia
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Jianhui Cui
- Department of Rehabilitation Medicine (Jianhua), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Xiali Xue
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Zhiguang Tian
- Department of Orthopedics, Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China.
| |
Collapse
|
2
|
Melo AS, Moreira JS, Afreixo V, Moreira-Gonçalves D, Donato H, Cruz EB, Vilas-Boas JP, Sousa AS. Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:161-174. [PMID: 38706660 PMCID: PMC11065746 DOI: 10.1016/j.xrrt.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Background Therapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Methods Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. Results From the 8318 records identified, 8 (high to low risk of bias- scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: -0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Conclusions Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
Collapse
Affiliation(s)
- Ana S.C. Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Juliana S. Moreira
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| | - Vera Afreixo
- Department of Mathematics, Center for Research and Development in Mathematics and Applications – CIDMA, University of Aveiro, Portugal
| | - Daniel Moreira-Gonçalves
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- ITR, Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Helena Donato
- Documentation and Scientific Information Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo B. Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J. Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia S.P. Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
| |
Collapse
|
3
|
Silveira A, Lima C, Beaupre L, Chepeha J, Jones A. Shoulder specific exercise therapy is effective in reducing chronic shoulder pain: A network meta-analysis. PLoS One 2024; 19:e0294014. [PMID: 38683828 PMCID: PMC11057978 DOI: 10.1371/journal.pone.0294014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/24/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exercise therapy (ET) is frequently an early treatment of choice when managing shoulder pain, yet evidence on its efficacy to expedite recovery is inconsistent. Moreover, the value of adding adjunct therapies (i.e. injections, manual therapy, electrotherapy) to ET is currently unclear. This study combined both direct and indirect evidence across studies on the effectiveness of ET with/without adjunct therapies compared to usual medical care for adults with chronic shoulder pain. METHODS AND FINDINGS Using a network meta-analysis, randomized control trials comparing ET along with adjunct therapies were identified in MEDLINE, Embase, CINAHL, Sportdiscus, CENTRAL, Conference Proceedings Citation Index-Science, clinicaltrials.gov, and association websites. Outcomes included pain, range of motion (ROM), and health-related quality of life (HRQL) measures in adult patients with chronic shoulder pain. Data analysis used a Frequentist hierarchical model. CINeMA tool assessed the confidence in the results and Cochrane Risk of Bias tool assessed quality of studies. 54 studies primarily from Europe (40.38%) included 3,893 participants who were followed up to 52 weeks. Shoulder-specific ET (Mean difference (MD) = -2.1; 95% confidence interval (CI) = -3.5 to -0.7) or in combination with electro-physical agents (MD = -2.5; 95% CI = -4.2 to -0.7), injections (MD = -2.4; 95% CI = -3.9 to-1.04) or manual therapy (MD = -2.3; 95% CI = -3.7 to -0.8) decreased pain compared to usual medical care. Trends with ROM and HRQL scores were seen; however, only Manual Therapy (MD = -12.7 and 95% CI = -24.4 to -1.0) achieved meaningfully important changes. Sensitivity analysis excluding studies with high risk of bias showed similar results, with exception of injections that did not reach significance (MD = -1.3; 95% CI = -4.3 to 1.7). CONCLUSION(S) Shoulder-specific ET provided pain relief up to 52 weeks. Adjunct therapies to shoulder-specific ET added little value in reducing pain. The quality of evidence varied between moderate and very low.
Collapse
Affiliation(s)
- Anelise Silveira
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Camila Lima
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - Lauren Beaupre
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Judy Chepeha
- University of Alberta, Collaborative Orthopaedic Research, Edmonton, Alberta, Canada
| | - Allyson Jones
- University of Alberta, Faculty of Rehabilitation Sciences, Edmonton, Alberta, Canada
| |
Collapse
|
4
|
Augusto DD, Scattone Silva R, Pinheiro DP, Sousa CDO. Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey. PLoS One 2024; 19:e0301326. [PMID: 38625895 PMCID: PMC11020769 DOI: 10.1371/journal.pone.0301326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/14/2024] [Indexed: 04/18/2024] Open
Abstract
The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.
Collapse
Affiliation(s)
- Denise Dal’Ava Augusto
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Rodrigo Scattone Silva
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Rehabilitation Sciences, Health Sciences College of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Débora Pereira Pinheiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
5
|
Marc T, Morana C. Effectiveness of a joint mobilizations protocol for shoulder subacromial pain syndrome: A pilot study. J Bodyw Mov Ther 2024; 38:574-582. [PMID: 38763611 DOI: 10.1016/j.jbmt.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Subacromial pain syndrome (SPS) is the most frequent shoulder pathology. The aims of this prospective randomized study were to evaluate the effects of some specific shoulder joint mobilizations ("spin correction"), and the effectiveness of a rehabilitation program, named Shoulder Global Concept, in SPS patients. METHODS 45 patients with SPS were randomly assigned to two groups, to benefit from a different first session of mobilizations: the experimental group received all specific mobilizations, while the control group received the same program but without the spin correction mobilizations. The second session was identical for both groups, with all specific mobilizations. Before and after the first two sessions, range of motion (ROM) in flexion, abduction, external and internal rotations, pain and functional status with Constant score and Quick Dash were evaluated. Evaluation was repeated with 24 patients after 11 rehabilitation sessions. Rehabilitation with Shoulder Global Concept included 13 mobilizations aiming at improving the ROM with passive and active-assisted mobilizations, static stretching, and muscle strengthening. RESULTS All ROM were improved at the end of the first session for both groups, but significantly more in the experimental group for glenohumeral (GH) abduction and external rotation (p < 0.05). Functional scores, pain and strength were significantly improved after 11 rehabilitation sessions with the Shoulder Global Concept. CONCLUSION This manual therapy method was able to improve shoulder mobility in one session. The additional joint mobilizations (spin correction) specifically increased GH abduction and external rotation. Rehabilitation of SPS with Shoulder Global Concept allowed to improve functional capacity and decrease pain.
Collapse
Affiliation(s)
- Thierry Marc
- Centre de Rééducation Spécialisé, Montpellier, France
| | - Claire Morana
- Centre de Rééducation Spécialisé, Montpellier, France.
| |
Collapse
|
6
|
Góngora-Rodríguez J, Rosety-Rodríguez MÁ, Rodríguez-Almagro D, Martín-Valero R, Góngora-Rodríguez P, Rodríguez-Huguet M. Structural and Functional Changes in Supraspinatus Tendinopathy through Percutaneous Electrolysis, Percutaneous Peripheral Nerve Stimulation and Eccentric Exercise Combined Therapy: A Single-Blinded Randomized Clinical Trial. Biomedicines 2024; 12:771. [PMID: 38672127 PMCID: PMC11048338 DOI: 10.3390/biomedicines12040771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Shoulder tendinopathies produce pain and reduce functionality. The aim of this randomized clinical trial was to analyze the effects of Percutaneous electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS) and eccentric exercise (EE) on pain (NPRS), strength, electromyographic activity, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and functionality (DASH and SPADI) in individuals with supraspinatus tendinopathy. Participants (n = 50) were divided into two groups; they received 4 treatment sessions, 1 per week, of PE and PNS (n = 25) or 10 treatment sessions of TENS and US (n = 25). Both groups performed the EE program consisting of 3 sets of 10 repetitions of each of the 3 exercises, twice a day, during the 4 weeks. Follow-up was carried out at 4, 12 and 24 weeks after the start of the intervention. There are statistically significant differences in the analysis between groups (p < 0.001) in the post-treatment and follow-up measurements favorable to the PE+PNS+EE treatment on pain (NPRS), strength, supraspinatus electromyographic amplitude, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and DASH and SPADI questionnaires. The combined treatment with PE, PNS and EE is an effective option in the clinical management of tendinopathies, with positive results in the short and long term on the variables studied.
Collapse
Affiliation(s)
- Jorge Góngora-Rodríguez
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (J.G.-R.); (M.R.-H.)
| | - Miguel Ángel Rosety-Rodríguez
- Move-It Research Group, Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain
| | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, 29071 Málaga, Spain;
| | | | - Manuel Rodríguez-Huguet
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (J.G.-R.); (M.R.-H.)
| |
Collapse
|
7
|
Leatherwood W, Torres A, Hidalgo Perea S, Paulus M. Demographic and Diagnostic Factors in Physical Therapy Attendance. Cureus 2024; 16:e55908. [PMID: 38601391 PMCID: PMC11004832 DOI: 10.7759/cureus.55908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Physical therapy (PT) is an effective nonoperative treatment for various orthopedic diagnoses. However, patients may have many reasons to dismiss PT, including favoring another intervention for their injury, time constraints, transportation, and cost. This dismissal of PT may contribute to inadequate patient compliance. This study aimed to elucidate patient compliance with a basic PT prescription and whether PT led to subjective injury improvement. Methods This is a retrospective study of patients observed in Stony Brook Orthopedic clinics from 08/01/2022 to 12/23/2022. Patients prescribed PT received a phone call six weeks after the PT prescription. The primary outcome was patient attendance at PT. Secondary outcomes were subjective; symptomatic improvement was listed as better, worse, or the same. Chi-square testing was used to compare outcomes. Results A total of 100 patients were enrolled in the study. Patients prescribed PT following surgery were more likely to attend compared to patients prescribed PT as a primary treatment (P value=0.027). The association between attendance at PT and a change in subjective symptoms (better, worse, same) was not significant. Patients' age, sex, and chronicity of injury were not significant factors in PT attendance. Of the 40 patients who did not attend PT, 14 cited time constraints, 11 utilized self-directed treatment, three cited insurance, two cited transportation, and 10 cited other reasons. Conclusions Overall, postoperative patients were more likely to attend PT compared to patients prescribed PT as a primary treatment. Factors such as age, sex, and chronicity of injury did not affect whether a patient attended PT. Of the patients enrolled, 71% stated subjective improvement in symptoms, but there was no association between symptoms and PT attendance. This study highlights the characteristics of those patient factors that may influence PT compliance and underscores the importance of further research into the population most likely to attend and benefit from PT.
Collapse
Affiliation(s)
| | - Adrian Torres
- Department of Orthopaedic Surgery, Stony Brook University, New York, USA
| | | | - Megan Paulus
- Department of Orthopaedic Surgery, Stony Brook University, New York, USA
| |
Collapse
|
8
|
Lowry V, Lavigne P, Zidarov D, Matifat E, Cormier AA, Desmeules F. A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders. Arch Phys Med Rehabil 2024; 105:411-426. [PMID: 37832814 DOI: 10.1016/j.apmr.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To perform a systematic review of clinical practice guidelines (CPGs) covering the management of common shoulder disorders. DATA SOURCES A systematic search of CPGs on specific shoulder disorders was conducted up to August 2022 in relevant databases. STUDY SELECTION Twenty-six CPGs on rotator cuff (RC) tendinopathy, RC tear, calcific tendinitis, adhesive capsulitis, glenohumeral (GH) instability, GH osteoarthritis, or acromioclavicular disorders published from January 2008 onward were screened and included. DATA EXTRACTION CPGs methodological quality was assessed with the AGREE II checklist. All recommendations from CPGs were extracted and categorized by shoulder disorder and care components (evaluation, diagnostic imaging, medical, rehabilitation, and surgical treatments). After semantic analysis of the terminology, recommendations for each shoulder disorders were classified by 2 reviewers into "recommended," "may be recommended," or "not recommended." Disagreements were resolved by discussion until reviewers reached consensus. DATA SYNTHESIS Only 12 CPGs (46%) were of high quality with major limitations related to the applicability and editorial independence of the guidelines. The initial evaluation of shoulder pain should include patient's history, subjective evaluation focused on red flags, and clinical examination. Magnetic resonance imaging is usually not recommended to manage early shoulder pain, and recommendations for X-rays are conflicting. Acetaminophen, oral non-steroidal anti-inflammatory drugs, and rehabilitation including exercises were recommended or may be recommended to treat all shoulder pain disorders. Guidelines on surgical management recommendations differed; for example, 6 CPGs reported that acromioplasty was recommended or may be recommended in chronic RC tendinopathy, whereas 4 CPGs did not recommend it. CONCLUSIONS Recommendations vary for diagnostic imaging, conservative vs surgical treatment to manage shoulder pain, although several care components are consensual. The development of evidence-based, rigorous CPGs with a valid methodology and transparent reporting is warranted to improve overall shoulder pain care.
Collapse
Affiliation(s)
- Véronique Lowry
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada.
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada; Surgery Department, Medicine Faculty, University of Montreal, Montreal, Canada
| | - Diana Zidarov
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Interdisciplinary Rehabilitation Montreal Research Center (CRIR), Montreal, Canada; Montreal University Institute for Physical Impairment Rehabilitation (IURDPM), Montreal, Canada
| | - Eveline Matifat
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
| | | | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, Canada
| |
Collapse
|
9
|
Ekefjärd S, Piussi R, Hamrin Senorski E. Physical symptoms among professional gamers within eSports, a survey study. BMC Sports Sci Med Rehabil 2024; 16:18. [PMID: 38225628 PMCID: PMC10790447 DOI: 10.1186/s13102-024-00810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND There is a need to establish the prevalence of self-reported physical symptoms such as pain in professional gamers (PGs) and to analyse whether there are correlations between lifestyle factors and self-reported physical symptoms. The purpose of this study was to analyse the prevalence of self-reported physical symptoms including eye-related problems in PGs. A further aim was to analyse the association between physical symptoms and lifestyle factors such as sleep time, play time and physical activity. METHODS This study was designed as a cross-sectional study with data based on an electronic survey, created specifically for this study, through discussion and screening of established validated questionnaires for physical symptoms in musculoskeletal conditions: the Karolinska Sleep Questionnaire and the Nordic Musculoskeletal Questionnaire. The survey comprised age and years of experience as a PG as descriptive variables, as well as questions on sleep, play time, physical activity and physical symptoms for the purpose of analysis. The directors of 10 professional gaming corporations were contacted by email with a link to the study-specific survey to distribute to all employees. RESULTS A total of 40 answers to the electronic survey were retrieved from 40 PGs, of which 62.5% (n = 25) had experienced at least one physical symptom in the three months prior to answering the survey. There was a significant association between playing time and physical symptoms (OR = 8.0; 95% CI 1.4-44.6, p = 0.018), where playing for more than 35 h a week was positively associated with eight times higher odds of experiencing physical symptoms. CONCLUSION There is a high prevalence of physical symptoms, such as headache and eye symptoms, in professional eSports gamers. There was an association between playing more than 35 h per week with the prevalence of physical symptoms.
Collapse
Affiliation(s)
- Staffan Ekefjärd
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Ramana Piussi
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden.
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30, Gothenburg, Sweden
| |
Collapse
|
10
|
Eraslan L, Yar O, Ergen FB, Huri G, Duzgun I. Utilizing Scapula Retraction Exercises With or Without Glenohumeral Rotational Exercises With a Gradual Progression for Subacromial Pain Syndrome. Sports Health 2024; 16:97-108. [PMID: 36872599 PMCID: PMC10732103 DOI: 10.1177/19417381231155190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Although exercise interventions are recommended in the management of subacromial pain syndrome (SPS), there is a lack of data regarding the exercises focusing on the principal biomechanical deficiencies that cause symptoms. HYPOTHESIS Utilizing progressive scapula retraction exercises (SRE) and glenohumeral rotation exercises (GRE) in the scapula stabilization program may lead to more reduction in symptoms and greater acromiohumeral distance (AHD) values. STUDY DESIGN A double-blind, randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS A total of 33 patients were assigned randomly to either SRE or SRE+GRE. Both groups received a 12-week supervised rehabilitation program, including manual therapy and exercises (stretching and progressive scapula stabilization exercises). In addition, the SRE+GRE group performed GRE exercises at gradual elevation angles. From 12 to 24 weeks, patients performed exercise programs less frequently (3 times per week). Disability (shoulder pain and disability index [SPADI]), AHD (at 5 active abduction angles), pain intensity (visual analogue scale [VAS]), and patient satisfaction were recorded at baseline, 12 weeks, and 24 weeks. A total of 16 healthy individuals were recruited as a control group to compare AHD values. Data were analyzed using mixed model analyses of variance. RESULTS A statistically significant group-by-time interaction was found for AHD values (F4,92 = 6.38; P = 0.001), a significant group-by-time interaction for SPADI-disability (F1,33 = 5.148; P = 0.01), SPADI-total (F1,32 = 4.172; P = 0.03), and for pain during activity (F2,62 = 3.204; P = 0.05). However, no significant group-by-time interaction for SPADI-pain (F1,33 = 0.533; P = 0.48), for pain at rest (F1,31 < 0.001; P = 0.99), and at night (F1,32 = 2.166; P = 0.15). Yet, a significant time effect was observed. CONCLUSION Progressive SRE and GRE in the scapula stabilization program lessens symptoms and improves AHD values in patients with SPS. Moreover, this program could preserve outcomes and further increase AHD when applied less frequently. CLINICAL RELEVANCE Utilizing SRE and GRE in the scapula stabilization program at gradual shoulder abduction angles provides better rehabilitation outcomes.
Collapse
Affiliation(s)
- Leyla Eraslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Ozan Yar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Fatma Bilge Ergen
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gazi Huri
- Department of Orthopaedic and Traumatology, Hacettepe University, Ankara, Turkey
| | - Irem Duzgun
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| |
Collapse
|
11
|
Cao Z, Li Q, Li Y, Wu J. The association of metabolic syndrome with rotator cuff tendinopathy: a two-sample Mendelian randomization study. Diabetol Metab Syndr 2023; 15:211. [PMID: 37875953 PMCID: PMC10594889 DOI: 10.1186/s13098-023-01189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Observational research reported the underlying correlation of metabolic syndrome (MetS) and its components with rotator cuff tendinopathy (RCT), but their causality remained unclear. This study aimed to investigate whether genetically predicted MetS was related to the risk of RCT. METHODS Both univariable and multivariable Mendelian randomization (MR) analysis was applied using summary-level data from the most comprehensive genome-wide association studies to estimate the associations of MetS and its component with RCT, with the inverse variance weighted (IVW) as the primary method, and the method of Causal Analysis Using Summary Effect Estimates (CAUSE) as a supplement for false positives detection. The mediation analysis was furtherly used for the assessment of direct and indirect effects. RESULTS Univariable analysis revealed that genetically predicted MetS (OR: 1.0793; 95% CI 1.0311 to 1.1297), body mass index (BMI) (OR 1.2239; 95% CI 1.1357 to 1.3189), and waist circumference (WAC) (OR 1.3177; 95% CI 1.2015 to 1.4451) had a significant positive association with the risk of RCT. Triglycerides and systolic blood pressure were suggestively associated with RCT risk. These associations were also identified by CAUSE. There was independent causality of BMI (OR: 1.1806; 95% CI 1.0788 to 1.2920) and WAC (OR 1.3716; 95% CI 1.2076 to 1.5580) on RCT after adjustment for confounders. No mediator was found in the causal associations. CONCLUSION Our study revealed the genetic causality of MetS and its components, especially BMI and WAC, with RCT risk. Early prevention and diagnosis of excess central adiposity contributing to MetS are significant in the RCT risk management.
Collapse
Affiliation(s)
- Ziqin Cao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qiangxiang Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Hui Autonomous Region, Yinchuan, 750001, Ningxia, China
- Department of Hunan Institute of Geriatrics, Hunan People's Hospital, Changsha, China
| | - Yajia Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Jianhuang Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
12
|
Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess 2023; 27:1-389. [PMID: 37929629 PMCID: PMC10641714 DOI: 10.3310/tfws2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship. Limitations Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future work There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study registration This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - David Brandie
- Sportscotland Institute of Sport, Airthrey Road, Stirling, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Isabelle Harrison
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Colin MacLean
- Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Laura Mitchell
- NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK
| | - Dylan Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK
| | - Rachel Ann Moss
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | | | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| |
Collapse
|
13
|
Beales D, Mitchell T, Seneque D, Chang SY, Cheng TH, Quek Y, Ranford S. Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers' Compensation System. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:506-517. [PMID: 36520348 DOI: 10.1007/s10926-022-10088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Investigate components of care for rotator cuff related shoulder pain in workers' compensation in relation to claim outcomes (claim duration, total medical spend, total claim cost, return to work outcome). METHODS Engagement with (had care, time to care) four components of care (prescribed exercise, imaging, injections, surgery) were obtained from auditing 189 closed workers' compensation files. Associations were analysed between components of care and claim outcomes. RESULTS 80% received prescribed exercise, 81% imaging, 42% injection and 35% surgery. Median time to imaging (11 days) was shorter than the prescribed exercise (27 days), with injection at 38 days and surgery 118.5 days. With univariable regression analysis higher age, the involvement of legal representation and the presence of rotator cuff pathology from diagnostic imaging (partial thickness tear or full thickness tear) were all associated with increased claim duration, total medical spend, total claim cost and less successful return to work outcomes. After adjusting for these three associations, having an injection or surgery were both positively associated with longer claim duration and greater medical spend, and surgery with greater total claim costs. In general, longer time to receiving components of care was associated with increased claim duration and reduced odds of returning to full duties at work. CONCLUSION Early management was not consistent with clinical guidelines for managing workers' compensation rotator cuff related shoulder pain. This may negatively affect claims outcomes.
Collapse
Affiliation(s)
- Darren Beales
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
- Pain Options, Ground Floor, 7 Hardy Street, South Perth, WA, 6151, Australia.
| | - Tim Mitchell
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Pain Options, Ground Floor, 7 Hardy Street, South Perth, WA, 6151, Australia
| | - David Seneque
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Shin Yin Chang
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Tak Ho Cheng
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - YiHui Quek
- Curtin enAble Institute and Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Stephen Ranford
- Pain Options, Ground Floor, 7 Hardy Street, South Perth, WA, 6151, Australia
| |
Collapse
|
14
|
Knowledge and appropriateness of care of family physicians and physiotherapists in the management of shoulder pain: a survey study in the province of Quebec, Canada. BMC PRIMARY CARE 2023; 24:49. [PMID: 36797670 PMCID: PMC9933814 DOI: 10.1186/s12875-023-01999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Shoulder pain is difficult to diagnose and treat with half of those affected still symptomatic six months after initial consultation. This may be explained by primary care management not conforming to evidence-based practice. This survey evaluated physiotherapists (PTs) and family physicians' (FPs) knowledge and appropriateness of care in shoulder pain management. METHODS A survey sent to PTs and FPs in the province of Quebec, Canada presented four clinical vignettes with cases of rotator cuff (RC) tendinopathy, acute full-thickness RC tear, adhesive capsulitis and traumatic anterior glenohumeral instability. Respondents indicated diagnosis, indications for imaging, specialists' referrals, and choice of treatments. Answers were compared to recommendations from clinical practice guidelines (CPGs). Participants' responses were compared between types of providers with Fisher's exact test. RESULTS Respondents (PTs = 175, FPs = 76) were mostly women with less than ten years of experience. More than 80% of PTs and 84% of FPs correctly diagnosed cases presented. Despite this practice not being recommended, more FPs than PTs recommended an imaging test in the initial management of RC tendinopathy (30% compared to 13%, p = 0.001) and adhesive capsulitis (51% compared to 22%, p = 0.02). For full-thickness RC tear and shoulder instability, up to 72% of FPs and 67% of PTs did not refer to a specialist for a surgical opinion, although recommended by CPGs. For RC tendinopathy, 26% of FPs and 2% of PTs (p < 0.001) would have prescribed a corticosteroid infiltration, which is not recommended in the initial management of this disorder. For adhesive capsulitis, significantly more FPs (76%) than PTs (62%) (p < 0.001) suggested an intra-articular corticosteroid infiltration, as recommended by CPGs. For all presented vignettes, up to 95% of family physicians adequately indicated they would refer patients for physiotherapy. In prioritizing rehabilitation interventions, up to 42% of PTs did not consider active exercises as a priority and up to 65% selected passive modalities that are not recommended for all shoulder pain vignettes. CONCLUSIONS Most FPs and PTs were able to make adequate diagnoses and select appropriate treatments for shoulder pain, but practices opposed to evidence-based recommendations were chosen by several respondents. Further training of FPs and PTs may be needed to optimize primary care management of different shoulder disorders.
Collapse
|
15
|
Wahba MM, Selim M, Hegazy MM, Elgohary R, Abdelsalam MS. Eccentric Versus Concentric Exercises in Patients With Rheumatoid Arthritis and Rotator Cuff Tendinopathy: A Randomized Comparative Study. Ann Rehabil Med 2023; 47:26-35. [PMID: 36792052 PMCID: PMC10020054 DOI: 10.5535/arm.22150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To determine the efficacy of concentric vs. eccentric exercise in improving shoulder function, pain, and tendon characteristics for patients with rheumatoid arthritis and rotator cuff tendinopathy. METHODS Forty patients with rheumatoid arthritis and rotator cuff tendinopathy were divided into either concentric or eccentric exercise groups, with 20 patients in each group. Patients received 12 sessions at a pace of 3 sessions per week. Shoulder Pain and Disability Index (SPADI), the visual analogue scale (VAS), supraspinatus and subscapularis thickness, echo pixels, and the Disease Activity Score-28-erythrocyte sedimentation rate (DAS-28-ESR) were assessed at baseline and post-treatment. RESULTS There was a significant difference between the concentric and eccentric groups regarding SPADI and VAS scores in favor of the eccentric group. However, there was no significant difference between the two groups regarding tendon thickness, echo pixels, or DAS-28-ESR. CONCLUSION Eccentric exercises were more effective than concentric exercises in improving shoulder function and pain intensity. However, neither of the two types of exercises was superior in improving tendon characteristics or disease activity.
Collapse
Affiliation(s)
- Mina Magdy Wahba
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
- Corresponding author: Mina Magdy Wahba Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Entertainment Area, Badr City, Cairo 11829, Egypt. Tel: +20-01285170876, Fax: +20-28650400, E-mail:
| | - Mona Selim
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Badr University in Cairo, Cairo, Egypt
| | - Mohammed Moustafa Hegazy
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Rasmia Elgohary
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Shawki Abdelsalam
- Department of Physical Therapy for Musculoskeletal Disorders and Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| |
Collapse
|
16
|
Atar MÖ, Korkmaz N, Aslan SG, Tezen Ö, Köylü SU, Demir Y, Kesikburun S. Comparison of ultrasound-guided subacromial corticosteroid and ozone (O 2-O 3) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial. Korean J Pain 2023; 36:128-136. [PMID: 36533317 PMCID: PMC9812695 DOI: 10.3344/kjp.22221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background : The authors aimed to compare the effects of a one-time ultrasound (US)-guided subacromial corticosteroid injection and three-time ozone (O2-O3) injection in patients with chronic supraspinatus tendinopathy. Methods : Participants were randomly assigned to the corticosteroid group (n = 22) or ozone group (n = 22). Injections in both groups were administered into subacromial bursa with an US-guided in-plane posterolateral approach. Primary outcome measure was the change in the Western Ontario Rotator Cuff Index (WORC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale and Shoulder Pain and Disability Index scores. Assessments were recorded at baseline, and 4-weeks and 12-weeks post-injection. Results : Forty participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both the groups showed clinically significant improvements in shoulder pain, quality of life, and function. Baseline, 4-week post-injection, and 12-week post-injection WORC scores (mean ± standard deviation) were 57.91 ± 18.97, 39.10 ± 20.50 and 37.22 ± 27.31 in the corticosteroid group, respectively and 69.03 ± 15.89, 39.11 ± 24.36, and 32.26 ± 24.58 in the ozone group, respectively. However, no significant group × time interaction was identified regarding all outcome measures. Conclusions : Three-time ozone injection was not superior to a one-time corticosteroid injection in patients with chronic supraspinatus tendinopathy. It might be as effective as corticosteroid injection at 4-weeks and 12-weeks post-injection in terms of relieving pain and improving quality of life and function.
Collapse
Affiliation(s)
- Merve Örücü Atar
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey,Correspondence: Merve Örücü Atar Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Universiteler Mahallesi, Lodumlu Yolu 29, Ekim Sk. No:1, 06800 Çankaya, Ankara, Turkey, Tel: +90 312 291 2443, Fax: +90 312 291 1009, E-mail:
| | - Nurdan Korkmaz
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sefa Gümrük Aslan
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Özge Tezen
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, Ankara, Turkey
| | - Sinem Uyar Köylü
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Yasin Demir
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Serdar Kesikburun
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
17
|
Prado W, Azevedo V, de Lucca SR, Bandini M. Shoulder arthralgia: case study of the Occupational Medicine clinic of Universidade Estadual de Campinas (Unicamp). Rev Bras Med Trab 2022; 20:555-562. [PMID: 37101440 PMCID: PMC10124813 DOI: 10.47626/1679-4435-2022-789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Shoulder pain is ranked as the third most common musculoskeletal complaint in clinical practice. It is estimated that 65 to 70% of these occurrences are due to rotator cuff injuries. A significant number of rotator cuff syndrome cases are work related. Objectives To evaluate the success or failure of therapeutic and administrative procedures for workers treated at an occupational medicine outpatient clinic. Methods This study analyzed the medical reports of 142 workers treated for shoulder pain between January 2015 and December 2019. To homogenize the information, medical record review was necessary in some cases. Results Rotator cuff syndrome was diagnosed in 84% of the cases after imaging exams. Conservative treatment was recommended for 88% of these patients and 58% required subsequent surgical treatment. Regarding rehabilitation, 51% of the patients were able to return to work and 49% returned to the same job function. Conclusions Diagnosing rotator cuff syndrome requires clinical and occupational history assessment, as well as imaging examinations, and the sensitivity and specificity of ultrasound were similar to magnetic resonance imaging. Removal from work and its risks must be an integral part of treatment. Upon returning to work, the rehabilitation and reintegration process should involve activities that will not worsen the injury.
Collapse
Affiliation(s)
- William Prado
- Departamento de Saúde Coletiva, Área de Saúde
do Trabalhador, Faculdade de Ciências Médicas, Universidade Estadual
de Campinas, Campinas, SP, Brazil
| | - Valmir Azevedo
- Departamento de Saúde Coletiva, Área de Saúde
do Trabalhador, Faculdade de Ciências Médicas, Universidade Estadual
de Campinas, Campinas, SP, Brazil
| | - Sérgio Roberto de Lucca
- Departamento de Saúde Coletiva, Área de Saúde
do Trabalhador, Faculdade de Ciências Médicas, Universidade Estadual
de Campinas, Campinas, SP, Brazil
| | - Marcia Bandini
- Departamento de Saúde Coletiva, Área de Saúde
do Trabalhador, Faculdade de Ciências Médicas, Universidade Estadual
de Campinas, Campinas, SP, Brazil
| |
Collapse
|
18
|
Handgrip Strength Exercises Modulate Shoulder Pain, Function, and Strength of Rotator Cuff Muscles of Patients with Primary Subacromial Impingement Syndrome. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9151831. [PMID: 36082154 PMCID: PMC9448609 DOI: 10.1155/2022/9151831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022]
Abstract
Background Impingement syndrome was shown to be associated with shoulder pain in 44–70% of patients worldwide. It usually occurs due to imbalance and insufficient activation of the rotator cuff (RC) muscles. Aim This study explores the relative effects of handgrip-strengthening exercises on shoulder function, pain, strength, and active range of motion as part of the treatment program for the patients with primary subacromial impingement syndrome. Materials and Methods A total of 58 patients aged 18-50 years with primary subacromial impingement syndrome were randomly enrolled to participate in this single-blind randomized clinical trial. Out of them, only forty patients have eligibly matched the inclusion criteria and randomly assigned to one of two groups to undergo a standardized therapeutic program consisting of two sessions a week for 8 weeks. The control group prescribed ultrasound therapy, ice, and stretching exercises, while the experimental group followed the same program with the addition of handgrip-strengthening exercises (HGSE). Both patients of conventional therapy (control) and handgrip-strengthening exercises (experimental group) were advised to adhere also to stretching and HGSE exercises once a day at home for eight weeks. The outcomes were the shoulder function, pain intensity, muscle strength, and active range of motion of the shoulder joint. Results Patients treated with conventional interventions plus handgrip-strengthening exercises showed the significant improvement over time in shoulder pain and function, strength of rotator cuff muscles, and pain-free range of motion forward flexion, abduction, and external and internal rotation through eight weeks in the experimental group compared to control patient group treated with conventional interventions. In addition, patients of both control and experimental groups showed no significant difference in the adherence to respective home-based stretching and HGSE exercises once a day at home for eight weeks. Conclusions Adding handgrip-strengthening exercises to conventional intervention increases the efficacy of treatment for patients with primary subacromial impingement syndrome in terms of shoulder function, pain, muscle strength, and active range of motion.
Collapse
|
19
|
Gallardo Vidal MI, Calleja Delgado L, Tenezaca Marcatoma JC, Calleja Guadix I, Daimiel Yllera A, Morales Tejera D. [Physiotherapy and health education protocol in chronic musculoskeletal shoulder pain. Experience in Primary Care]. Aten Primaria 2022; 54:102284. [PMID: 35461039 PMCID: PMC9046942 DOI: 10.1016/j.aprim.2022.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/28/2021] [Accepted: 01/02/2022] [Indexed: 11/12/2022] Open
Abstract
Objetivo Evaluar la experiencia de un programa de educación para la salud en atención primaria en pacientes con dolor de hombro crónico de origen musculoesquelético, sobre el dolor y la discapacidad e instaurar el protocolo en atención primaria. Diseño Estudio observacional descriptivo longitudinal quasi-experimental. Emplazamiento Centro de Salud Arroyo de la Vega. Alcobendas, Madrid. Participantes Pacientes remitidos por su médico de atención primaria a la unidad de fisioterapia de atención primaria por dolor de hombro de origen musculoesquelético. Intervención Siete sesiones grupales de educación para la salud y ejercicio terapéutico. Mediciones principales Se valoró la intensidad del dolor a través de la escala visual analógica, la discapacidad del miembro superior con el cuestionario Disabilities of the Arm, Shoulder and Hand y el nivel de discapacidad y dolor de hombro con el questionario Shoulder Pain and Disability Index. Resultados Se encontraron diferencias estadísticamente significativas en la reducción del dolor y la discapacidad (p < 0,01), además se redujo el consumo de fármacos y las recidivas. Conclusiones El protocolo de fisioterapia de hombro con educación para la salud fue eficaz para reducir el dolor y la discapacidad en pacientes con dolor de hombro crónico, de origen musculoesquelético, en atención primaria.
Collapse
Affiliation(s)
- María Isabel Gallardo Vidal
- Unidad de Fisioterapia, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España; Departamento de Fisioterapia, Universidad de Antonio Nebrija, Madrid, España
| | - Leonor Calleja Delgado
- Unidad de Medicina, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España
| | | | - Iván Calleja Guadix
- Unidad de Medicina, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España
| | - Alicia Daimiel Yllera
- Unidad de Fisioterapia, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España; Departamento de Fisioterapia, Universidad de Antonio Nebrija, Madrid, España; Unidad de Medicina, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España; Escuela Internacional de Doctorado, Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo CEU, Campus de Montepríncipe, Madrid, España
| | - David Morales Tejera
- Unidad de Fisioterapia, Gerencia de Atención Primaria de la Comunidad de Madrid, Madrid, España; Escuela Internacional de Doctorado, Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Universidad Rey Juan Carlos, Alcorcón, Madrid, España; Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo CEU, Campus de Montepríncipe, Madrid, España.
| |
Collapse
|
20
|
Cheimonidou AZ, Stergioulas A, Lamnisos D, Galanis P, Stasinopoulos D. The Greek version of shoulder rating questionnaire (SRQ): Translation, cultural adaptation, a reliability and validity study in patients with rotator cuff related shoulder pain. Physiother Theory Pract 2022:1-9. [PMID: 35209798 DOI: 10.1080/09593985.2022.2040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Shoulder Rating Questionnaire (SRQ) was created in the English language to assess shoulder disorders in six areas: global function, pain, daily activities, recreational and athletic activities, and work. PURPOSE The study aimed to translate and culturally adapt Shoulder Rating Questionnaire (SRQ) into Greek. METHODS The SRQ English version was translated and adapted into the Greek language using forward translation, expert panel synthesis, and backward translation procedures. A pilot testing has been made in the target population, and the final version was created. A cross-sectional study was conducted in clinical settings with the SRQ and the Shoulder Pain and Disability Index. A total of 168 Greek adult patients with rotator cuff-related shoulder pain were recruited from physical therapy clinics. Τhe reliability of the SRQ Greek version was assessed using intraclass correlation coefficients. Internal consistency was assessed using the Cronbach alpha coefficient. Concurrent validity was measured by correlating the Shoulder Rating Questionnaire with the Shoulder Pain and Disability Index using Pearson's correlation coefficient. RESULTS The results showed that the SRQ Greek version has excellent internal consistency (Cronbach's α = 0.99), test-retest reliability (ICC = 0.976), and concurrent validity (r > 0.9). No ground or ceiling effects were found. The standard error of measurement and the minimum detectable change of the total score were 5.55 and 15.38. CONCLUSIONS The Greek Language Version of the SRQ is a reliable and valid instrument that can be used to evaluate adult patients with shoulder rotator cuff-related disorders in the acute or chronic phases and in clinical trials.
Collapse
Affiliation(s)
- Areti Zoe Cheimonidou
- Program of Physiotherapy, Department of Health Sciences, School of Sciences, European University of Cyprus 6, Diogenes Str. Engomi, Nicosia, Cyprus
| | - Apostolos Stergioulas
- Program of Physiotherapy, Department of Health Sciences, School of Sciences, European University of Cyprus 6, Diogenes Str. Engomi, Nicosia, Cyprus
| | - Demetris Lamnisos
- Program of Physiotherapy, Department of Health Sciences, School of Sciences, European University of Cyprus 6, Diogenes Str. Engomi, Nicosia, Cyprus
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Laboratory of Neuromuscular and Cardiovascular Study of Motion (Lanecasm), Egaleo, Greece
| |
Collapse
|
21
|
Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2022; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/20/2022] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. Virtual Reality has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
Collapse
Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|
22
|
Schydlowsky P, Szkudlarek M, Madsen OR. Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial. BMC Musculoskelet Disord 2022; 23:52. [PMID: 35033043 PMCID: PMC8760780 DOI: 10.1186/s12891-021-04969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. 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. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS 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. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.
Collapse
Affiliation(s)
| | - Marcin Szkudlarek
- Reumatologiklinikken i Værløse, Bymidten 11,1, 3500, Værløse, Denmark.,Department of Rheumatology, Zealand University Hospital at Køge, Køge, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Gentofte University Hospital and Rigshospitalet, DK-2900, Hellerup, Denmark
| |
Collapse
|
23
|
Chatterjee M, Muljadi PM, Andarawis-Puri N. The role of the tendon ECM in mechanotransduction: disruption and repair following overuse. Connect Tissue Res 2022; 63:28-42. [PMID: 34030531 DOI: 10.1080/03008207.2021.1925663] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
Collapse
Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
24
|
Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG102. [PMID: 34338006 DOI: 10.2519/jospt.2021.0303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of restricted work, unemployment, and work disability. The primary purpose of this clinical practice guideline (CPG) is to systematically review available scientific evidence and provide a set of evidence-based recommendations for effective physical therapy evaluation, treatment, and management of individuals experiencing limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.
Collapse
|
25
|
Chen H, Li S, Xiao H, Wu B, Zhou L, Hu J, Lu H. Effect of Exercise Intensity on the Healing of the Bone-Tendon Interface: A Mouse Rotator Cuff Injury Model Study. Am J Sports Med 2021; 49:2064-2073. [PMID: 33989078 DOI: 10.1177/03635465211011751] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries at the bone-tendon interface (BTI) are common findings in clinical practice. Rehabilitation procedures after BTI surgery are important but are controversial. PURPOSE To investigate the effects of different exercise intensities on BTI healing by means of an established mouse rotator cuff injury model. STUDY DESIGN Controlled laboratory study. METHODS A total of 150 specific pathogen free male C57BL/6 mice, with supraspinatus insertion injury, were randomly assigned to 1 of 5 groups according to postoperative rehabilitation of different exercise intensities: (1) control group, (2) low-intensity exercise group, (3) moderate-intensity exercise group, (4) high-intensity exercise group, and (5) increasing-intensity exercise group (IG). The specimens were harvested 4 or 8 weeks postoperatively for microarchitectural, histological, molecular biological, and mechanical evaluations. RESULTS Histological test results showed that the degrees of tissue fusion and polysaccharide protein distribution at the healing interface at 4 and 8 weeks after surgery were significantly better in the IG than in the other 4 groups. Synchrotron radiation micro-computed tomography showed that the quantity of subchondral bone at the enthesis (bone volume/total volume fraction, trabecular thickness, trabecular number) was higher and trabecular separation was lower in the IG than in the other 4 groups. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) analysis revealed that the healing interface in the IG expressed more transcription factors, such as sox 9, runx 2, and scleraxis, than the interfaces in the other groups. Although no significant difference was seen in the cross-sectional area between the groups at postoperative weeks 4 and 8 (P > .05), the tensile load, ultimate strength, and stiffness of the specimens in the IG were significantly better than those in the other 4 groups (P < .05). CONCLUSION The rehabilitation program with increasing-intensity exercise was beneficial for BTI healing. CLINICAL RELEVANCE The results of this study provide evidence supporting the use of a simple and progressive exercise rehabilitation program after rotator cuff surgery.
Collapse
Affiliation(s)
- Huabin Chen
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Shengcan Li
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Han Xiao
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Bing Wu
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Li Zhou
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
- Department of Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| |
Collapse
|
26
|
Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Kazempour Mofrad R, Abdorrazaghi F, Azizi S. Periarticular Neurofascial Dextrose Prolotherapy Versus Physiotherapy for the Treatment of Chronic Rotator Cuff Tendinopathy: Randomized Clinical Trial. J Clin Rheumatol 2021; 27:136-142. [PMID: 32975923 DOI: 10.1097/rhu.0000000000001218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Rotator cuff tendinopathy is a common cause of shoulder pain. We aimed to compare periarticular (neurofascial) dextrose prolotherapy versus physiotherapy for treatment of chronic rotator cuff tendinopathy in the short term. METHODS We carried out a randomized clinical trial with 2 arms at a university hospital. In total, 66 patients with chronic rotator cuff tendinopathy, proven by magnetic resonance imaging, were randomly allocated to 2 groups. The outcomes were change in shoulder pain intensity (primary) and disability (secondary) index using a questionnaire for Shoulder Pain and Disability Index. For physiotherapy, participants received superficial heat, transcutaneous electrical nerve stimulation, and pulsed ultrasound. Also, they carried out an exercise program, 10 sessions of 30 minutes for 3 weeks. For prolotherapy, we used 8 mL of 12.5% dextrose and 40 mg of 2% lidocaine. The mixture was injected 2 times with 1-week interval superficially around the shoulder joint and to tender points along the suprascapular nerve. RESULTS Neurofascial dextrose was more effective than physiotherapy for alleviating pain in 2 weeks (p < 0.001), and they were similar 3 months after the interventions (p = 0.055). For disability, dextrose was more effective than physiotherapy 2 weeks and 3 months (both p < 0.001) after the interventions. However, the changes in the physiotherapy group seemed to be more sustained. CONCLUSIONS Both interventions are effective for the short-term management of rotator cuff tendinopathy. However, prolotherapy is more successful as the initial treatment. Besides, the treatment time is much shorter for dextrose prolotherapy compared with physiotherapy.
Collapse
Affiliation(s)
- Morteza Kazempour Mofrad
- From the Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences
| | - Zahra Rezasoltani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | - Afsaneh Dadarkhah
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | | | - Fateme Abdorrazaghi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| | - Sirous Azizi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences
| |
Collapse
|
27
|
Supervised Training Compared With No Training or Self-training in Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 102:2428-2441.e10. [PMID: 33930326 DOI: 10.1016/j.apmr.2021.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the effects of supervised training in adults with subacromial pain syndrome. DATA SOURCES Embase, MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database were searched from inception to March 2020. STUDY SELECTION Independent reviewers selected randomized controlled trials comparing supervised training with (1) no training or (2) self-training in adults with subacromial pain syndrome lasting for at least 1 month. Critical outcomes were shoulder pain, function, and patient-perceived effect. Important outcomes included other potential benefits and adverse events at 3-month follow-up. DATA EXTRACTION Two independent reviewers extracted data for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool 1, and certainty of evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS Ten studies (n=597, 43% female) were included. Supervised training resulted in larger improvements than no training on pain (at rest: n=286; mean difference [MD], 1.68; 95% confidence interval [CI], 0.31-3.06 on 0-10 scale; during movement: n=353; MD, 1.84; 95% CI,0.91-2.76), function (n=396; standardized MD, 0.30; 95% CI, 0.07-0.52), and patient-perceived effect (n=118; risk ratio, 1.43; 95% CI, 0.87-2.34). Supervised training had potential benefits regarding quality of life, return to work, dropout, and training adherence, albeit more patients reported mild, transient pain after training. Supervised training and self-training showed equal improvements on pain (n=44) and function (n=76), with no data describing patient-perceived effect. Certainty of evidence was low for critical outcomes and low-moderate for other outcomes. CONCLUSIONS Supervised training might be superior to no training and equally effective as self-training on critical and important outcomes. Based on low-moderate certainty of evidence, these findings support a weak recommendation for supervised training in adults with subacromial pain syndrome.
Collapse
|
28
|
Brady N, Lewis J, McCreesh K, Dejaco B, McVeigh JG. Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol. HRB Open Res 2021; 4:40. [PMID: 35155988 PMCID: PMC8808320 DOI: 10.12688/hrbopenres.13239.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. VR has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.
Collapse
Affiliation(s)
- Niamh Brady
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Evolve Health, Cork, Ireland
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
- Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar
| | - Karen McCreesh
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Beate Dejaco
- Sports Medical Centre Papendal, Arnhem, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | |
Collapse
|
29
|
Dominguez-Romero JG, Jiménez-Rejano JJ, Ridao-Fernández C, Chamorro-Moriana G. Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics (Basel) 2021; 11:529. [PMID: 33809604 PMCID: PMC8002167 DOI: 10.3390/diagnostics11030529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Rotator cuff (RC) tendinopathy causes pain and functional limitation of the shoulder. Physical exercises are effective therapies but there is no consensus on which exercise programme is the most appropriate. Objective: To analyze and compare the effectiveness of different intervention modalities-based exclusively on physical exercise muscle-development programs to improve shoulder pain and function in RC tendinopathy. (2) Methods: Systematic review (PRISMA) through a search in PubMed, WOS, PEDro, Cinahl, Scopus and Dialnet. The PEDro Scale and the Cochrane Risk of Bias analyzed the methodological quality. A pre-established table collected data on: patients, interventions, outcome measures and results. A narrative synthesis of the results was conducted. (3) Results: eight articles were selected (Cochrane: low risk of bias; PEDro: good quality). All assessed programs were effective. Only one study found statistically and clinically significant differences in favour of eccentric training. The exercises used were: eccentric/concentric/conventional, open/closed kinetic chain, with/without co-activation of glenohumeral muscle, with/without pain, and in clinic/at home. (4) Conclusions: All exercise programs were effective in RC tendinopathy, improving pain and shoulder function. No solid results were obtained when the interventions were compared due to their heterogeneity. Patients perception assessment tools were the most widely used. Amount of load applied should be considered.
Collapse
Affiliation(s)
| | | | | | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, University of Seville, 41009 Seville, Spain; (J.G.D.-R.); (J.J.J.-R.); (C.R.-F.)
| |
Collapse
|
30
|
Challoumas D, Millar NL. Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment. BMJ Open Sport Exerc Med 2021; 7:e000920. [PMID: 33692904 PMCID: PMC7907875 DOI: 10.1136/bmjsem-2020-000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment. Data sources Medline from inception to June 2020. Study eligibility All SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy. Data extraction and synthesis Included SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication. Results A total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately. Conclusions In light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.
Collapse
Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
31
|
Burns D, Boyer P, Razmjou H, Richards R, Whyne C. Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study. JMIR Rehabil Assist Technol 2021; 8:e21374. [PMID: 33704076 PMCID: PMC8082948 DOI: 10.2196/21374] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 12/12/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown. OBJECTIVE The purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation. METHODS We report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses. RESULTS Mean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation. CONCLUSIONS There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/17841.
Collapse
Affiliation(s)
- David Burns
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Philip Boyer
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Helen Razmjou
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Working Condition Program, Holland Orthopedic and Arthritic Centre, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Robin Richards
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Cari Whyne
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
32
|
Ribeiro DC, Spiers K, Thomas L, Leilua K, Wilkes M, Norton S, Lamb SE. Monitoring, implementation and reporting of interventions in a selection of trials assessing exercise therapy for the management of shoulder subacromial pain: a cross-sectional investigation. BMJ Open 2021; 11:e044462. [PMID: 33593786 PMCID: PMC7888324 DOI: 10.1136/bmjopen-2020-044462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain. DESIGN A review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain. METHODS We included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC). RESULTS TIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%. CONCLUSIONS Little information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials.
Collapse
Affiliation(s)
- Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kate Spiers
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Laura Thomas
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kiriffi Leilua
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Matthew Wilkes
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Shontal Norton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
33
|
Auliffe SM, Korakakis V, Hilfiker R, Whiteley R, O'Sullivan K. Participant characteristics are poorly reported in exercise trials in tendinopathy: A systematic review. Phys Ther Sport 2020; 48:43-53. [PMID: 33360409 DOI: 10.1016/j.ptsp.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy. METHODS Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria. RESULTS The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used. CONCLUSION The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups.
Collapse
Affiliation(s)
- Seán Mc Auliffe
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar.
| | | | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Leukerbad, Switzerland
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland
| |
Collapse
|
34
|
Challoumas D, Millar NL. Risk of bias in systematic reviews of tendinopathy management: Are we comparing apples with oranges? TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Neal L. Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences University of Glasgow Glasgow UK
| |
Collapse
|
35
|
Girgis B, Duarte JA. Physical therapy for tendinopathy: An umbrella review of systematic reviews and meta-analyses. Phys Ther Sport 2020; 46:30-46. [PMID: 32877858 DOI: 10.1016/j.ptsp.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs). METHODS Electronic search of PubMed, PEDro, and Scopus database was performed from year 2010 to January 2020. The methodological quality of the identified studies was assessed using the AMSTAR 2 tool. Studies scoring 9 points or higher were further analyzed using GRADE principles. RESULTS 40 SRs and/or MAs were included in qualitative synthesis, whereas only 5 MAs were included in quantitative synthesis. Low-level laser therapy (LLLT) intervention showed a pooled improvement in pain reduction of 1.53 cm; 95% CI, [1.14, 1.91] (I2 = 1.9%, p = 0.361) on visual analogue scale, and grip strength of 9.59 kg; 95% CI, [5.90, 13.27]. CONCLUSIONS Moderate-quality evidence may support these following interventions: LLLT revealed a statistically and potentially clinically significant improvement in pain and function on the short-term. Extracorporeal shockwave therapy showed a statistically significant enhancement in pain and function at all follow-up durations; however, its clinical significance was undetermined. Eccentric exercise was supported by qualitative evidence only. Caution is advised when interpreting results due to possible pathological differences in tendinopathy at each region.
Collapse
Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| | - José Alberto Duarte
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| |
Collapse
|
36
|
Clifford C, Challoumas D, Paul L, Syme G, Millar NL. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ Open Sport Exerc Med 2020; 6:e000760. [PMID: 32818059 PMCID: PMC7406028 DOI: 10.1136/bmjsem-2020-000760] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To systematically review and critically appraise the literature on the effectiveness of isometric exercise in comparison with other treatment strategies or no treatment in tendinopathy. Design A systematic review and meta-analysis of randomised controlled trials. Data sources Electronic searches of Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Cochrane were undertaken from inception to May 2020. Methods Overall quality of each study was determined based on a combined assessment of internal validity, external validity and precision. For each outcome measure, level of evidence was rated based on the system by van Tulder et al. Results Ten studies were identified and included in the review, including participants with patellar (n=4), rotator cuff (n=2), lateral elbow (n=2), Achilles (n=1) and gluteal (n=1) tendinopathies. Three were of good and seven were of poor overall quality. Based on limited evidence (level 3), isometric exercise was not superior to isotonic exercise for chronic tendinopathy either immediately following treatment or in the short term (≤12 weeks) for any of the investigated outcome measures. Additionally, for acute rotator cuff tendinopathy, isometric exercise appears to be no more effective than ice therapy in the short term (limited evidence; level 3). Summary Isometric exercise does not appear to be superior to isotonic exercise in the management of chronic tendinopathy. The response to isometric exercise is variable both within and across tendinopathy populations. Isometric exercise can be used as part of a progressive loading programme as it may be beneficial for selected individuals. PROSPERO registration number CRD42019147179.
Collapse
Affiliation(s)
- Christopher Clifford
- Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK.,Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Lorna Paul
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Grant Syme
- Department of Physiotherapy, NHS Fife, Kirkcaldy, Fife, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
37
|
Lowry V, Bass A, Lavigne P, Léger-St-Jean B, Blanchette D, Perreault K, Roy JS, Aiken A, Décary S, Desmeules F. Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study. J Shoulder Elbow Surg 2020; 29:1564-1572. [PMID: 32199757 DOI: 10.1016/j.jse.2019.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. METHODS Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers. RESULTS Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70). CONCLUSION APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.
Collapse
Affiliation(s)
- Veronique Lowry
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada.
| | - Alec Bass
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Patrick Lavigne
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - Benjamin Léger-St-Jean
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - David Blanchette
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada
| | - Kadija Perreault
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada; Faculty of Medicine, Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Jean-Sebastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Québec, QC, Canada; Faculty of Medicine, Department of Rehabilitation, Université Laval, Québec, QC, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Simon Décary
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Faculty of Medicine, Québec, QC, Canada
| | - François Desmeules
- Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montréal, QC, Canada; Faculty of Medicine, School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| |
Collapse
|
38
|
Scapular Kinematics in Athletes With and Without Rotator Cuff Tendinopathy: A Systematic Review. J Sport Rehabil 2020; 29:820-829. [DOI: 10.1123/jsr.2019-0095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 09/13/2019] [Accepted: 10/03/2019] [Indexed: 11/18/2022]
Abstract
Context: Rotator cuff tendinopathy is one of the most frequently reported shoulder injuries in athletes of overhead sports. Abnormal scapular kinematics has been proposed as one of the contributing factors of rotator cuff tendinopathy in overhead athletes. Objectives: To review the literature on 3-dimensional scapular kinematics in overhead athletes with and without rotator cuff tendinopathy. Evidence Acquisition: Electronic databases (Cochrane Library, MEDLINE, Embase, and PubMed) were searched from inception to September 2017. In addition, the reference lists of the articles that met the inclusion criteria were also searched. We included studies that compared the changes in 3-dimensional scapular kinematics in athletes with and without rotator cuff tendinopathy. Two reviewers independently examined the quality of studies by using the modified Downs and Black checklist. Evidence Synthesis: A total of 9 studies (a total of 332 athletes, mean age 23.41 [2.62] y) were included in the final analysis. The methodological quality was low (modified Downs and Black checklist = 9/15). Our findings showed a consistent pattern of increased scapular anterior tilting and internal rotation in the dominant shoulders than the nondominant shoulders of athletes who participated in overhead sports. Athletes of overhead sports seem to demonstrate an increase in scapular upward rotation during arm elevation when compared with nonathlete individuals. However, there is no consensus on the scapular kinematics pattern in athletes with rotator cuff tendinopathy when compared with healthy controls. Conclusion: Findings demonstrated that changes in scapular kinematics were observed in overhead athletes. However, all the included studies were cross-sectional studies with small sample size and diverse sports participation, whether changes in scapular kinematics may contribute to rotator cuff tendinopathy in overhead athletes warrants more high-quality prospective studies.
Collapse
|
39
|
Can a Conservative Rehabilitation Strategy Improve Shoulder Proprioception? A Systematic Review. J Sport Rehabil 2020; 30:136-151. [PMID: 32736342 DOI: 10.1123/jsr.2019-0400] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/23/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus prescribed in clinical practice. It is unclear whether nonsurgical rehabilitation can optimize shoulder proprioception. OBJECTIVES To summarize the available evidence of conservative rehabilitation (ie, nonsurgical) on proprioception among individuals with shoulder disorders. EVIDENCE ACQUISITION PubMed, Web of Science, and EBSCO were systematically searched, from inception until November 24, 2019. Selected articles were systematically assessed, and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were utilized for this review. The conservative treatments were categorized as follows: (1) conventional therapy, (2) proprioceptive training, (3) elastic kinesiology tape, and (4) other passive therapies. EVIDENCE SYNTHESIS Twelve articles were included, yielding 58 healthy control shoulders and 362 shoulders affected by impingement syndrome, glenohumeral dislocations, nonspecific shoulder pain, rotator cuff dysfunction, or subluxation poststroke. The level of agreement between the evaluators was excellent (84.9%), and the studies were evaluated to be of fair to excellent quality (risk of bias: 28.5%-100%). This review suggests, with moderate evidence, that proprioceptive training (upper-body wobble board or flexible foil training) can improve proprioception in the midterm. No decisive evidence exists to suggest that conventional therapy is of added value to enhance shoulder proprioception. Conflicting evidence was found for the improvement of proprioception with the application of elastic kinesiology tape, while moderate evidence suggests that passive modalities, such as microcurrent electrical stimulation and bracing, are not effective for proprioceptive rehabilitation of the shoulder. CONCLUSIONS Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic kinesiology tape does not appear to affect the sense of shoulder proprioception. This review suggests a possible specificity of training effect with shoulder proprioception.
Collapse
|
40
|
Burns D, Razmjou H, Shaw J, Richards R, McLachlin S, Hardisty M, Henry P, Whyne C. Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study. JMIR Res Protoc 2020; 9:e17841. [PMID: 32623366 PMCID: PMC7381014 DOI: 10.2196/17841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/26/2020] [Accepted: 04/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Physiotherapy is essential for the successful rehabilitation of common shoulder injuries and following shoulder surgery. Patients may receive some training and supervision for shoulder physiotherapy through private pay or private insurance, but they are typically responsible for performing most of their physiotherapy independently at home. It is unknown how often patients perform their home exercises and if these exercises are performed correctly without supervision. There are no established tools for measuring this. It is, therefore, unclear if the full benefit of shoulder physiotherapy treatments is being realized. Objective The proposed research will (1) validate a smartwatch and machine learning (ML) approach for evaluating adherence to shoulder exercise participation and technique in a clinical patient population with rotator cuff pathology; (2) quantify the rate of home physiotherapy adherence, determine the effects of adherence on recovery, and identify barriers to successful adherence; and (3) develop and pilot test an ethically conscious adherence-driven rehabilitation program that individualizes patient care based on their capacity to effectively participate in their home physiotherapy. Methods This research will be conducted in 2 phases. The first phase is a prospective longitudinal cohort study, involving 120 patients undergoing physiotherapy for rotator cuff pathology. Patients will be issued a smartwatch that will record 9-axis inertial sensor data while they perform physiotherapy exercises both in the clinic and in the home setting. The data collected in the clinic under supervision will be used to train and validate our ML algorithms that classify shoulder physiotherapy exercise. The validated algorithms will then be used to assess home physiotherapy adherence from the inertial data collected at home. Validated outcome measures, including the Disabilities of the Arm, Shoulder, and Hand questionnaire; Numeric Pain Rating Scale; range of motion; shoulder strength; and work status, will be collected pretreatment, monthly through treatment, and at a final follow-up of 12 months. We will then relate improvement in patient outcomes to measured physiotherapy adherence and patient baseline variables in univariate and multivariate analyses. The second phase of this research will involve the evaluation of a novel rehabilitation program in a cohort of 20 patients. The program will promote patient physiotherapy engagement via the developed technology and support adherence-driven care decisions. Results As of December 2019, 71 patients were screened for enrollment in the noninterventional validation phase of this study; 65 patients met the inclusion and exclusion criteria. Of these, 46 patients consented and 19 declined to participate in the study. Only 2 patients de-enrolled from the study and data collection is ongoing for the remaining 44. Conclusions This study will provide new and important insights into shoulder physiotherapy adherence, the relationship between adherence and recovery, barriers to better adherence, and methods for addressing them. International Registered Report Identifier (IRRID) DERR1-10.2196/17841
Collapse
Affiliation(s)
- David Burns
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Helen Razmjou
- Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Working Condition Program, Holland Orthopedic and Arthritic Centre, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - James Shaw
- Women's College Research Institute, Toronto, ON, Canada.,Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
| | - Robin Richards
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Michael Hardisty
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick Henry
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Cari Whyne
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.,Holland Bone and Joint Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| |
Collapse
|
41
|
An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther 2020; 50:131-141. [PMID: 31726927 DOI: 10.2519/jospt.2020.8498] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To update a systematic review published in 2013 that focused on evaluating the effectiveness of interventions within the scope of physical therapy, including exercise, manual therapy, electrotherapy, and combined or multimodal approaches to managing shoulder pain. DESIGN Umbrella review. LITERATURE SEARCH An electronic search of PubMed, Web of Science, and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) checklist for systematic reviews. STUDY SELECTION CRITERIA Nonsurgical treatments for subacromial shoulder pain. DATA SYNTHESIS Sixteen systematic reviews were retrieved. Results were summarized qualitatively. RESULTS A strong recommendation can be made for exercise therapy as the first-line treatment to improve pain, mobility, and function in patients with subacromial shoulder pain. Manual therapy may be integrated, with a strong recommendation, as additional therapy. There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound. CONCLUSION There is a growing body of evidence to support exercise therapy as an intervention for subacromial shoulder pain. Ongoing research is required to provide guidance on exercise type, dose, duration, and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase. J Orthop Sports Phys Ther 2020;50(3):131-141. Epub 15 Nov 2019. doi:10.2519/jospt.2020.8498.
Collapse
|
42
|
Ager AL, Roy JS, Gamache F, Hébert LJ. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2020; 184:e385-e393. [PMID: 30423137 DOI: 10.1093/milmed/usy294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. MATERIALS AND METHODS Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T0), 6 (T6) and 12 (T12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. RESULTS Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. CONCLUSIONS Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.
Collapse
Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - France Gamache
- Physiotherapy Department, Valcartier Garrison, Canadian Armed Forces, Quebec, Canada
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Department of Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,1 Canadian Field Hospital, Detachment Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
43
|
Trøstrup J, Mikkelsen LR, Frost P, Dalbøge A, Høybye MT, Casper SD, Jørgensen LB, Klebe TM, Svendsen SW. Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study). Trials 2019; 20:627. [PMID: 31718683 PMCID: PMC6852773 DOI: 10.1186/s13063-019-3703-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background In Denmark, exercise therapy in combination with work modification is the first-choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will more effectively reduce (1) shoulder complaints and (2) occupational shoulder exposures than an individual-based Shoulder-Guidance intervention (active control – enhanced usual care). Methods A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18–65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder-exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-orientated counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6-month follow-up (hypothesis I), and the mean number of min/day with the arm elevated > 60° shortly after the end of the intervention (hypothesis II). We will use a mixed-model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle. Discussion Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation. Trial registration Clinicaltrials.gov, ID: NCT03159910. Registered on 18 May 2017
Collapse
Affiliation(s)
- Jeanette Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark. .,Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.
| | - Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Terp Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lene Bastrup Jørgensen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Martin Klebe
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| |
Collapse
|
44
|
Riel H, Jensen MB, Olesen JL, Vicenzino B, Rathleff MS. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial. J Physiother 2019; 65:144-151. [PMID: 31204294 DOI: 10.1016/j.jphys.2019.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
QUESTION For people with plantar fasciopathy, is a 12-week self-dosed heavy-slow resistance training program more beneficial than a 12-week pre-determined heavy-slow resistance training program? DESIGN A randomised trial with concealed allocation, partial blinding, and intention-to-treat analysis. PARTICIPANTS Seventy people with plantar fasciopathy confirmed on ultrasonography. INTERVENTION Both groups performed a repeated heel raise exercise in standing for 12 weeks. Participants in the experimental group were self-dosed (ie, they performed as many sets as possible with as heavy a load as possible, but no heavier than 8 repetition maximum). The exercise regimen for the control group was pre-determined (ie, it followed a standardised progressive protocol). OUTCOME MEASURES The primary outcome was the Foot Health Status Questionnaire pain domain. Secondary outcomes included: a 7-point Likert scale of Global Rating of Change dichotomised to 'improved' or 'not improved'; Patient Acceptable Symptom State defined as when participants felt no further need for treatment; and number of training sessions performed. RESULTS There was no significant between-group difference in the improvement of Foot Health Status Questionnaire pain after 12 weeks (adjusted MD -6.9 points, 95% CI -15.5 to 1.7). According to the Global Rating of Change, 24 of 33 in the experimental group and 20 of 32 in the control group were improved (RR = 1.16, 95% CI 0.83 to 1.64). Only four participants achieved Patient Acceptable Symptom State: three of 35 in the experimental group and one of 35 in the control group. No significant between-group difference was found in the number of training sessions that were performed (MD -2 sessions, 95% CI -8 to 3). CONCLUSION Self-dosed and pre-determined heavy-slow resistance exercise programs are associated with similar effects on plantar fasciopathy pain and other outcomes over 12 weeks. Advising people with plantar fasciopathy to self-dose their slow-heavy resistance training regimen did not substantially increase the achieved dose compared with a pre-determined regimen. These regimens are not sufficient to achieve acceptable symptom state in the majority of people with plantar fasciopathy. REGISTRATION ClinicalTrials.govNCT03304353.
Collapse
Affiliation(s)
- Henrik Riel
- Center for General Practice at Aalborg University, Aalborg, Denmark.
| | | | | | - Bill Vicenzino
- Sports Injury Rehabilitation and Prevention for Health Research Unit, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark; Department of Physical and Occupational Therapy, Aalborg University Hospital, Brisbane, Australia; SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| |
Collapse
|
45
|
The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther 2019; 49:126-135. [PMID: 30501388 DOI: 10.2519/jospt.2019.8240] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatments for rotator cuff tendinopathy include rotator cuff muscle strengthening to promote better muscle recruitment in order to minimize subacromial narrowing during active movement. Glenohumeral adductor recruitment has also been shown to prevent such narrowing in asymptomatic individuals; therefore, adding glenohumeral adductor coactivation during rotator cuff strengthening could enhance the efficacy of rotator cuff strengthening. However, no study has explored its benefits. OBJECTIVES To compare the short-term efficacy of adding glenohumeral adductor coactivation to a rotator cuff-strengthening program to improve function, reduce symptoms, and increase acromiohumeral distance in adults with rotator cuff tendinopathy. METHODS In this single-blind randomized controlled trial, 42 participants with rotator cuff tendinopathy were randomly assigned to 2 groups, one that received strengthening of the scapular and rotator cuff muscles or one that received rotator cuff strengthening plus coactivation with pectoralis major and latissimus dorsi recruitment. The daily programs were performed at home for 6 weeks, with supervised training and follow-up sessions. Functional limitations/symptoms (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire as the primary outcome, and the Western Ontario Rotator Cuff index), pain (visual analog scale), and acromiohumeral distance were measured at baseline, 3 weeks, and 6 weeks. Data were analyzed using a mixed-model analysis of variance. RESULTS No significant group-by-time interaction was observed for the Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index, visual analog scale, and acromiohumeral distance (P≥.055). Significant time effects were obtained for the Western Ontario Rotator Cuff index and visual analog scale for pain with movement (P<.001). CONCLUSION The present findings show that adding glenohumeral adductor coactivation to a rotator cuff-strengthening program does not result in improved short-term efficacy in any of the measured outcomes. This study was registered with ClinicalTrials.gov (NCT02837848). LEVEL OF EVIDENCE Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(3):126-135. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8240.
Collapse
|
46
|
Spargoli G. SUPRASPINATUS TENDON PATHOMECHANICS: A CURRENT CONCEPTS REVIEW. Int J Sports Phys Ther 2018; 13:1083-1094. [PMID: 30534473 PMCID: PMC6253746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Tendinopathy of the supraspinatus muscle is a frequent cause of shoulder pain. Although it is a common condition, the pathophysiology is not fully understood. The purpose of this clinical commentary is to provide an overview of the pathophysiology of supraspinatus tendinopathy and discuss the conservative treatment solutions. DESCRIPTION Supraspinatus tendinopathy is thought to be caused by both intrinsic, and extrinsic factors. Structural and biological changes happen when tendinopathy develops. Cellular and extracellular modifications characterize tendon healing stages that continue over time. Assessment is paramount in order to differentiate the structure involved, and to offer a proper treatment solution. RELATION TO CLINICAL PRACTICE Knowledge of the general concepts regarding the development of supraspinatus tendinopathy, and of the healing process should guide physiotherapists when proposing treatment options. Physical modalities commonly utilized for supraspinatus tendinopathy such as: laser, ultrasound, and shock-wave therapy have little and contradictory evidence. Exercise in form of eccentric training may be considered as it seems to have beneficial effects, however, more research is needed.
Collapse
|
47
|
Holdaway LA, Hegmann KT, Thiese MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord 2018; 19:408. [PMID: 30470225 PMCID: PMC6260856 DOI: 10.1186/s12891-018-2319-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Glenohumeral pain and rotator cuff tendinopathy (RCT) are common musculoskeletal complaints with high prevalence among working populations. The primary proposed pathophysiologic mechanisms are sub-acromial RC tendon impingement and reduced tendon blood flow. Some sleep postures may increase subacromial pressure, potentially contributing to these postulated mechanisms. This study uses a large population of workers to investigate whether there is an association between preferred sleeping position and prevalence of: (1) shoulder pain, and (2) rotator cuff tendinopathy. METHODS A cross-sectional analysis was performed on baseline data from a multicenter prospective cohort study. Participants were 761 workers who were evaluated by questionnaire using a body diagram to determine the presence of glenohumeral pain within 30 days prior to enrollment. The questionnaire also assessed primary and secondary preferred sleep position(s) using 6 labeled diagrams. All workers underwent a structured physical examination to determine whether RCT was present. For this study, the case definition of RCT was glenohumeral pain plus at least one of a positive supraspinatus test, painful arc and/or Neer's test. Prevalence of glenohumeral pain and RCT were individually calculated for the primary and secondary sleep postures and odds ratios were calculated. RESULTS Age, sex, Framingham cardiovascular risk score and BMI had significant associations with glenohumeral pain. For rotator cuff tendinopathy, increasing age, Framingham risk score and Hand Activity Level (HAL) showed significant associations. The sleep position anticipated to have the highest risk of glenohumeral pain and RCT was paradoxically associated with a decreased prevalence of glenohumeral pain and also trended toward being protective for RCT. Multivariable logistic regression showed no further significant associations. CONCLUSION This cross-sectional study unexpectedly found a reduced association between one sleep posture and glenohumeral pain. This cross-sectional study may be potentially confounded, by participants who are prone to glenohumeral pain and RCT may have learned to avoid sleeping in the predisposing position. Longitudinal studies are needed to further evaluate a possible association between glenohumeral pain or RCT and sleep posture as a potential risk factor.
Collapse
Affiliation(s)
- Lincoln A Holdaway
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA.
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, 161 W Wisconsin Ave, Suite 6000, Milwaukee, WI, 53203-2602, USA
| |
Collapse
|
48
|
Kelly D, Shorthouse F, Roffi V, Tack C. Exercise therapy and work-related musculoskeletal disorders in sedentary workers. Occup Med (Lond) 2018; 68:262-272. [DOI: 10.1093/occmed/kqy054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Kelly
- Occupational Health Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - F Shorthouse
- Occupational Health Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - V Roffi
- Occupational Health Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - C Tack
- Occupational Health Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| |
Collapse
|
49
|
Kinsella R, Cowan SM, Watson L, Pizzari T. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2017; 3:45. [PMID: 29163981 PMCID: PMC5684744 DOI: 10.1186/s40814-017-0190-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 09/26/2017] [Indexed: 01/10/2023] Open
Abstract
Background Subacromial pain syndrome (SPS) involving rotator cuff tendinopathy is a common cause of shoulder pain and disability. Evidence suggests that structured physiotherapy may be as effective as surgery in this condition with significant improvements demonstrated in trials involving scapular retraining, rotator cuff strengthening and flexibility exercises. Most published programs typically utilise isotonic concentric and/or eccentric strengthening modes. Recently, immediate analgesic effects and muscle strength gains following heavy-load isometric exercises in lower limb tendinopathy conditions have been observed. It is pertinent to ascertain whether such outcomes can be replicated in SPS/rotator cuff tendinopathy. The primary aim of this study is to establish the feasibility of undertaking a full-scale randomised controlled trial (RCT) that compares the effects of isometric, isotonic concentric and isotonic eccentric rotator cuff contractions when used as part of a semi-standardised exercise-based physiotherapy program in patients diagnosed with SPS. The secondary aim is to explore potential trends or treatment effects of the exercise intervention. Methods Thirty-six participants diagnosed with SPS will be randomised to one of three intervention groups and undergo a one-on-one exercise-based physiotherapy intervention, involving scapular and rotator cuff muscle retraining and strengthening. Each group will utilise a different mode of rotator cuff strengthening—isometric, isotonic concentric or isotonic eccentric. Rotator cuff tendon responses to isometric loading are not yet established in the literature; hence, individualised, progressive loading will be used in this pilot study in accordance with symptoms. The intervention will involve two phases: during Phase 1 (weeks 1–6) participants undertake the active group-specific physiotherapy treatment; in Phase 2 (weeks 6–12), they undertake a progressive, but no longer group-specific exercise program. To determine feasibility, an evaluation of key study parameters including (a) ease of recruitment (rate and number as well as suitability of the assessment algorithm), (b) adherence to all phases of the exercise intervention including home program compliance and logbook completion, (c) participant non-completion (drop out number and rate) and (d) adverse events (nature and number) will be undertaken. Secondary outcomes will measure immediate effects: (i) within-treatment changes in pain perception (verbal rating scale (VRS) and shoulder muscle strength (hand-held dynamometer) as well as longer-term changes: (ii) shoulder-related symptoms and disability (Western Ontario Rotator Cuff Index (WORC) and Shoulder Pain and Disability Index (SPADI)), (iii) perception of pain (11-point numerical rating scale (NRS), (iv) shoulder muscle strength (hand-held dynamometer) and (v) perceived global rating of change score. The immediate within-treatment assessment of pain and muscle strength will be undertaken in treatments 2 and 3, and the longer term measures will be collected at the primary (conclusion of Phase 1 at 6 weeks) and secondary (conclusion of Phase 2 at 12 weeks) end-points of the study. Discussion The findings of this pilot study will permit evaluation of this study design for a full-scale RCT. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001676404 Electronic supplementary material The online version of this article (10.1186/s40814-017-0190-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rita Kinsella
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Physiotherapy Department, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, Australia
| | - Sallie M Cowan
- Clifton Hill Physiotherapy, 111 Queens Parade, Clifton Hill, Melbourne, Australia.,University of Melbourne, School of Physiotherapy, Melbourne, Australia
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre, Prahran, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| |
Collapse
|