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  • Does the addition of motor control or strengthening exercises to education result in better outcomes for rotator cuff-related shoulder pain? A multiarm randomised controlled trial

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Original research
Does the addition of motor control or strengthening exercises to education result in better outcomes for rotator cuff-related shoulder pain? A multiarm randomised controlled trial
  1. Marc-Olivier Dubé1,2,
  2. François Desmeules3,4,
  3. Jeremy S Lewis5,
  4. Jean-Sébastien Roy1,2
  1. 1 Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Quebec, Canada
  2. 2 Faculty of Medicine, Department of Rehabilitation, Université Laval, Quebec, Quebec, Canada
  3. 3 Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
  4. 4 Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada
  5. 5 Therapy Department, Central London Community Healthcare NHS Trust, London, UK
  1. Correspondence to Jean-Sébastien Roy, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada; jean-sebastien.roy{at}fmed.ulaval.ca

Abstract

Objective To compare the short-term, mid-term and long-term effects between three interventions (education only, education and strengthening exercises, education and motor control exercises) for rotator cuff-related shoulder pain (RCRSP) on symptoms and function.

Methods 123 adults presenting with RCRSP took part in a 12-week intervention. They were randomly assigned to 1 of 3 intervention groups. Symptoms and function were evaluated at baseline and at 3 weeks, 6 weeks, 12 weeks and 24 weeks using the Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) (primary outcome) and Western Ontario Rotator Cuff Index (WORC). Linear mixed modelling was used to compare the effects of the three programmes on the outcomes.

Results After 24 weeks, between-group differences were −2.1 (-7.7 to 3.5) (motor control vs education), 1.2 (-4.9 to 7.4) (strengthening vs education) and −3.3 (-9.5 to 2.8) (motor control vs strengthening) for the QuickDASH and 9.3 (1.5 to 17.1) (motor control vs education), 1.3 (−7.6 to 10.2) (strengthening vs education) and 8.0 (−0.5 to 16.5) (motor control vs strengthening) for the WORC. There was a significant group-by-time interaction (p=0.04) with QuickDASH, but follow-up analyses did not reveal any clinically meaningful between-group differences. There was no significant group-by-time interaction (p=0.39) for the WORC. Between-group differences never exceeded the minimal clinically important difference of QuickDASH or WORC.

Conclusion In people with RCRSP, the addition of motor control or strengthening exercises to education did not lead to larger improvements in symptoms and function compared with education alone. Further research should investigate the value of providing stepped care by identifying individuals who may only need education and those who would benefit from the addition of motor control or strengthening exercises.

Trial registration number NCT03892603.

  • shoulder
  • rehabilitation
  • education
  • exercises
  • rotator cuff

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, J-SR, upon reasonable request.

https://doi.org/10.1136/bjsports-2021-105027

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, J-SR, upon reasonable request.

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    Footnotes

    • Twitter @marco_dube, @fdesmeulesptphd, @JeremyLewisPT, @RoyJeanSebasti1

    • Contributors M-OD, J-SR, FD and JSL designed the study and created the study protocol. M-OD and J-SR directed the publication. All authors contributed to writing and approved the final version of this manuscript. M-OD and J-SR are the guarantors.

    • Funding This work was supported by the Quebec Rehabilitation Research Network (REPAR). M-OD received a Doctoral Training Scholarship from the Fonds de Recherche Québec-Santé (FRQ-S). J-SR and FD are supported by salary awards from the FRQ-S.

    • Competing interests JSL conceptualised the SSMP concept, which was part of the movement or motor control program used in this study.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.