Thilo O Kromer1, Rob A de Bie, Caroline H G Bastiaenen. 1. School of Therapeutic Sciences, Department of Physiotherapy, SRH University Heidelberg, Heidelberg, The Netherlands. Thilo.Kromer@EPID.unimaas.nl, tok@ptz-physio.de, thilo.kromer@maastrichtuniversity.nl, ThiloOliver.Kromer@hochschule-heidelberg.de.
Abstract
OBJECTIVES: To investigate the effect of manual physiotherapy and exercises compared with exercises alone in patients with shoulder impingement syndrome one year after inclusion. DESIGN: Randomized controlled trial. SUBJECTS:Patients with shoulder impingement of more than 4 weeks. METHODS: The intervention group received individualized manual physiotherapy plus individualized exercises; the control group received individualized exercises only. Both groups had 10 treatments over 5 weeks; afterwards all patients continued their exercises for another 7 weeks at home. Primary outcomes were the Shoulder Pain and Disability Index and Patients' Global Impression of Change. The Generic Patient-Specific Scale was used as secondary outcome. Costs were recorded in a log-book. RESULTS:Ninety patients were included in the study and 87 could be analyzed at 1-year follow-up. Both groups showed significant improvements in all outcome measures, but no difference was detected between the groups. Only costs differed significantly in favour of the control group (p = 0.03) after 5 weeks. CONCLUSION:Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year. Exercises should therefore be considered as a basic treatment. Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months.
RCT Entities:
OBJECTIVES: To investigate the effect of manual physiotherapy and exercises compared with exercises alone in patients with shoulder impingement syndrome one year after inclusion. DESIGN: Randomized controlled trial. SUBJECTS:Patients with shoulder impingement of more than 4 weeks. METHODS: The intervention group received individualized manual physiotherapy plus individualized exercises; the control group received individualized exercises only. Both groups had 10 treatments over 5 weeks; afterwards all patients continued their exercises for another 7 weeks at home. Primary outcomes were the Shoulder Pain and Disability Index and Patients' Global Impression of Change. The Generic Patient-Specific Scale was used as secondary outcome. Costs were recorded in a log-book. RESULTS: Ninety patients were included in the study and 87 could be analyzed at 1-year follow-up. Both groups showed significant improvements in all outcome measures, but no difference was detected between the groups. Only costs differed significantly in favour of the control group (p = 0.03) after 5 weeks. CONCLUSION: Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year. Exercises should therefore be considered as a basic treatment. Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months.
Authors: François Desmeules; Jennifer Boudreault; Clermont E Dionne; Pierre Frémont; Véronique Lowry; Joy C MacDermid; Jean-Sébastien Roy Journal: J Occup Health Date: 2016-08-04 Impact factor: 2.708