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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.
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).
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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