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Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study
  1. Theresa Holmgren1,
  2. Hanna Björnsson Hallgren2,
  3. Birgitta Öberg1,
  4. Lars Adolfsson2,
  5. Kajsa Johansson1
  1. 1Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, SE-581 83, Linköping, Sweden
  2. 2Department of Orthopaedics, University Hospital, SE-581 85, Linköping
  1. Correspondence to : T Holmgren; theresa.holmgren{at}liu.se

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Design

This was a randomised, participant and single assessor blinded, controlled study. Patients were randomised to a specific exercise strategy, targeting the rotator cuff and scapula stabilisers, or to control exercises for 12 weeks. Patients in both groups received five to seven individual sessions with a physiotherapist during this period.

Participants and setting

From the department of orthopaedics, Linköping University Hospital, Sweden, we recruited 102 patients with long standing (more than six months) subacromial impingement syndrome in whom earlier conservative treatment had failed and who were on a waiting list for surgery.

Primary outcomes

The primary outcome was change in the Constant-Murley shoulder score between baseline and an assessment at three months. Secondary outcomes included patients' global impression of change because of treatment and their decision regarding surgery.

Main results and the role of chance

Overall, 97 (95%) participants completed the 12 week study. The specific exercise group had a significantly (P<0.001) greater improvement in the Constant-Murley score than the control exercise group (between group mean differences 15, 95% confidence interval 8.5 to 20.6). Significantly more patients in the specific exercise group reported a successful outcome (defined as a large improvement or recovered) in the patients' global impression of change because of treatment (69% (35/51) v 24% (11/46); odds ratio 7.6, 3.1 to 18.9; P<0.001). A significantly lower proportion of patients in the specific exercise group chose to undergo surgery (20% (10/51) v 63% (29/46); 7.7, 3.1 to 19.4; P<0.001).

Harms

None reported.

Bias, confounding, and other reasons for caution

Only one physiotherapist was involved in all the treatment and was not blinded to group assignment, which might have influenced the results. There was, however, a strict standardised study protocol and a blinded assessor.

Generalisability to other populations

All patients were recruited from the surgical waiting list of one orthopaedic clinic. This might affect the external validity of the results, but, as patients were referred from all primary care units in the region of Östergötland (population 427 106) we think that the included patients are representative of the studied population. The severity of symptoms and duration might be more heterogeneous in patients with subacromial impingement syndrome attending primary care than in the studied population. Therefore this positive effect of treatment needs to be confirmed in a primary care setting, with longer follow-up, before further implementation of this specific exercise strategy.

Study funding/potential competing interests

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. TH is funded in part by the research council in the south east of Sweden (FORSS).

Trial registration number

Clinical trials NCT01037673

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