Study characteristics | Participant characteristics | Intervention and setting | Outcome data/results |
Aasa et al (2015)43 Michaelson et al (2016)72 2 groups: 1. High-load lifting exercise 2. Low-load motor control exercises | 70 patients recruited from occupational healthcare services in Sweden (mean age 42, 56% female); inclusion criteria included: (a) adults with low back pain >3 months’ duration and (b) with or without leg pain | Physiotherapy clinic, sports centre and home setting 1. n=35; group exercises based at a sports centre (5 participants in each group), with pain up to 50 mm Visual Analogue Scale acceptable, such that the pain subsided after each set of exercises; 12 treatment sessions over an 8-week period (weeks 1–4, 2 sessions per week; weeks 5–8, 1 session per week); 60 min in duration; no home exercises 2. n=35; pain-free individual exercises at a physiotherapy centre; 12 treatment sessions over an 8-week period (weeks 1–4, 2 sessions per week; weeks 5–8, 1 session per week); 20–30 min in duration; exercises involved improving control around joint neutral positions; in supine, four-point kneeling, sitting, and/or standing positions; Plus home exercises, 10 repetitions 2–3× a day | Main outcome assessed at baseline, 2-month and 12-month follow-up was 7 day average pain on a Visual Analogue Scale (0–100 mm) and Roland-Morris Disability Questionnaire (0–24) Group 1: mean pain at baseline 43 (SD 24), 2 months 22 (SD 21), 12 months 24 (SD 27) and 24 months 27 (SD 27) Group 2: mean pain at baseline 47 (SD 28), 2 months 30 (SD 26), 12 months 25 (SD 22) and 24 months 30 (SD 29) Group 1: mean disability at baseline 7.2 (SD 4.3), 2 months 3.8 (SD 4.0), 12 months 3.6 (SD 4.2) and 24 months 3.8 (SD 3.9) Group 2: mean disability at baseline 7.1 (SD 3.9), 2 months 3.6 (SD 4.2), 12 months 3.3 (SD 3.6) and 24 months 3.6 (SD 3.7) Both groups had significant improvements in their pain and disability levels; no significant between-group difference for pain at any follow-up (2 months p=0.71; 12 months p=0.94; 24 months p=0.89); no significant between-group difference for disability at any follow-up (2 months p=0.77; 12 months p=0.74; 24 months p=0.99) |
Holmgren et al (2012)70 Hallgren et al (2014)71 2 groups: 1. Specific exercises group 2. Control exercise group Patients were given the option at 3 months of continuing to have an arthroscopic subacromial decompression. | 97 patients recruited from the waiting list for an arthroscopic subacromial decompression from a university hospital in Sweden (mean age 52, 37% female); inclusion criteria included (a) adults with lateral shoulder pain >6 months, (b) failed 3 months of previous primary care, (c) signs of impingement symptoms and (d) positive Neer’s impingement test of a subacromial anaesthetic injection | Physiotherapy and home setting 1. n=51; eccentric rotator cuff exercises and concentric/eccentric scapula exercises; recommendation of 5/10 numerical rating scale for pain during exercises, such that the pain subsided by the next exercise session; 7 physiotherapy appointment, weekly first 2 weeks, alternative weeks thereafter; exercises to be performed at home once or twice a day for 12 weeks 2. n=46; pain-free upper limb and neck exercises; 7 physiotherapy appointment, weekly first 2 weeks, alternative weeks thereafter; exercises to be performed at home once or twice a day for 12 weeks | Main outcome of Constant-Murley score (C-M) (0–100), along with shoulder assessment scores and pain scores taken at baseline, 3 months and 12 months, including pain at rest measured on Visual Analogue Scale (0–100 mm) Group 1: mean C-M at baseline 48 (SD 15), 3 months 72 (SD 19) and 12 months 83 (SD 14) Group 2: mean C-M at baseline 43 (SD 15), 3 months 52 (SD 23) and 12 months 76 (SD 18) Group 1: mean pain at rest at baseline 15 (SD 19), 3 months 10 (SD 14) and 12 months 2 (SD 6) Group 2: mean pain at rest at baseline 20 (SD 21), 3 months 20 (SD 25) and 12 months 4 (SD 13) Both groups had significant improvements in all outcomes at 3 months and 1 year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). |
Littlewood et al (2015)52 2 groups: 1. Self-managed exercises 2. Usual physiotherapy | 86 patients recruited from UK, NHS physiotherapy waiting list (mean age 55, 50% female); inclusion criteria included (a) adults with shoulder pain >3 months, (b) maintained shoulder ROM and (c) pain with resisted movements | Physiotherapy and home setting 1. n=42; single shoulder exercise guided by the symptomatic response, requiring pain to be produced during exercise, such that the pain subsided after the exercises; typically involving a weighted shoulder abduction exercise of 3 sets of 10–15 repetitions; pragmatic approach to number of follow-ups, timings of appointments and point of discharge; that is, the treating physiotherapist and patient will determine these factors 2. n=44; usual physiotherapy,* including advice, stretching, exercise, manual therapy, massage, strapping, acupuncture, electrotherapy, corticosteroid injection at the discretion of the treating physiotherapist; pragmatic approach to number of follow-ups, timings of appointments and point of discharge; that is, the treating physiotherapist and patient will determine these factors | Main outcome of the Shoulder Pain and Disability Index (SPADI) (0–100) at baseline, 3, 6 and 12 months Group 1: mean at baseline 49.1 (SD 18.3), 3 months 32.4 (SD 20.2), 6 months 16.6 (SD 19.7) and 12 months 14.2 (SD 20.0) Group 2: mean at baseline 49.0 (SD 18.0), 3 months 30.7 (SD 19.7), 6 months 24.0 (SD 19.7) and 12 months 21.4 (SD 25.4) Statistically significant and clinically important within group changes for SPADI from baseline to all three follow-up points. There were no statistically significant differences between the groups across all the outcomes at 3, 6 or 12 months, (p=0.75, 0.19 and 0.32, respectively). |
Maenhout et al (2013)47 2 groups: 1. Traditional rotator cuff training with heavy load eccentric training 2. Traditional rotator cuff training | 61 patients recruited from a shoulder surgeon’s clinic in Belgium (mean age 39.8, 41% female); inclusion criteria included (a) adults with >3 months of shoulder pain, (b) painful arc, (c) 2 out of 3 impingement tests, (d) pain on palpation of rotator cuff tendons | Physiotherapy and home setting 1. n=31; the same exercises as group 2, plus a heavy loaded eccentric exercise of abduction within the scapular plane; 3 sets of 15 repetitions, such that the patient experiences pain on the last set, up to 5/10 Visual Analogue Scale, such that the pain subsided by the following morning. 2. n=30; pain-free, traditional rotator cuff exercises of internal and external rotation with a resisted rubber band; performed once a day, with 3 sets of 10 repetitions; both groups had exercise prescription and monitoring through 9 physiotherapy appointments over 12 weeks | Main outcome of the SPADI (0–100) at baseline, 6 weeks and 12 weeks Group 1: mean at baseline 44.3 (SD 11.5), 6 weeks 17.7 (SD 12.0) and 12 weeks 14.5 (SD 11.7). Group 2: mean at baseline 42.0 (SD 11.0), 6 weeks 25.4 (SD 11.9) and 12 weeks 17.0 (SD 11.4) In both groups pain and function, measured with the SPADI score, improved significantly over time (p>0.001). When comparing between groups, improvement of the SPADI score was not significantly different. |
Nørregaard et al (2007)73 2 groups: 1. Eccentric exercises 2. Stretching exercises | 45 patients recruited from a clinic of sports medicine in Denmark (mean age 42, 49% female); inclusion criteria included (a) adults with Achilles pain >3 months, (b) local thickening >2 mm on ultrasound, (c) diffuse posterior ankle pain | Sports medicine clinic and home setting 1. n=21; information leaflet with home exercise programme on; to be performed twice a day, for 12 weeks; 1 follow-up appointment at 3 months; 3 sets of 15 repetitions of eccentric calf exercises, with knee straight and semi-flexed; patients told to expect pain during the exercises, but to avoid increasing daily pain or morning stiffness 2. n=24; information leaflet with home exercise programme on; to be performed twice a day, for 12 weeks; 1 follow-up appointment at 3 months; pain-free standing stretches for gastrocnemius and soleus; 5 repetitions of 30 s each | Outcome measures were tenderness on palpation, ultrasound and pain, as measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS) (0–4) and patient’s global assessment; follow-up was at baseline, 3, 6, 9, 12 weeks and 1 year Group 1: mean pain domain from KOOS at baseline 1.6 (SD 0.6), 3 weeks 0.1 (SD 0.1), 6 weeks 0.3 (SD 0.1), 9 weeks 0.4 (SD 0.2), 12 weeks 0.4 (SD 0.2) and 1 year score was 1.0 (SD 0.2) Group 2: mean pain domain from KOOS at baseline 1.6 (SD 0.6), 3 weeks 0.2 (SD 0.1), 6 weeks 0.3 (SD 0.1), 9 weeks 0.3 (SD 0.2), 12 weeks 0.4 (SD 0.2) and 1 year score was 0.7 (SD 0.2) There were significant improvements in all dimensions of the KOOS compared with baseline, with no differences between group differences. |
Rathleff et al (2015)51 2 groups: 1. High-load strengthening exercises 2. Stretching exercises | 48 patients recruited from a university hospital, regional hospital and private clinic in Denmark (mean age 46, 66% female); inclusion criteria included (a) adults with plantar fasciitis >3 months, (b) pain on palpation, (c) local thickening >4 mm on ultrasound | Home based exercises 1. n=24; information leaflet, heel inserts and a prescription of a high-load strength programme; consisting of single calf raises with a towel rolled up under the toes for maximum toe extension, activating the windlass mechanism; each calf raises was 3 s up, 2 s pause, 3 s down; weight was added in rucksacks, starting at 12 repetition maximum for three sets, and slowly progressed over 3 months; patients were advised to perform the exercise every other day; exercises were allowed to be painful, with no postincrease in pain. 2. n=24; information leaflet, heel inserts and a prescription of pain-free* plantar-specific stretches; patients were asked to stretch the plantar fascia in a cross-legged position by extending their toes, hold for 10 s, 10 times, 3× a day for 3 months | Primary outcome was Foot Function Index at 1, 3, 6 and 12 months, including pain at worse and pain on first step on a numerical rating scale (0–10). Mean scores for group 1 pain at worse at baseline was 7.9 (SD 1.7), 1 month 6.1 (95% CI 5.1 to 7.2), 3 months 3.5 (95% CI 2.3 to 4.7), 6 months 2.5 (95% CI 1.4 to 3.6) and 12 months 2.9 (95% CI 1.7 to 4.0). Mean scores for group 2 pain at worse at baseline was 7.5 (SD 1.6), 1 month 6.1 (95% CI 5.2 to 7.1), 3 months 6.1 (95% CI 4.4 to 7.7), 6 months 3.4 (95% CI 2.0 to 4.7) and 12 months 1.8 (95% CI 0.7 to 3.0). At 3 months group 1 had significantly lower pain scores than group 2 (p<0.05). At months 1, 6 and 12, there was no significant difference between groups. |
Silbernagel et al (2001)74 2 groups: 1. Eccentric exercises 2. Regular concentric/eccentric exercises | 40 patients recruited from mailings to hospitals, clinics and sports clubs in Sweden (mean age 45, 23% female); inclusion criteria included (a) adults with Achilles pain >3 months | Clinic and home setting 1. n=22; progressive eccentric exercise programme to be performed 2× a day, plus three sets of six different stretching exercises, 20 s each, as well as balance, toe/heel walking exercises; weekly physiotherapy contact for 12 weeks; pain was allowed during the exercises up to 5/10 Visual Analogue Scale, such that the pain subsided by the following morning with no morning stiffness 2. n=18. 3 x a day of regular concentric and eccentric calf strengthening, plus two sets of the stretching exercises from group 1. Physiotherapy contacts 3–5 x during the 12 weeks. Exercises must be pain-free. | Outcomes of pain on palpation (Visual Analogue Scale) (0–100 mm) taken at baseline, 6 weeks, 3 and 6 months. Other outcomes included pain on walking and pain on stairs (yes/no), various objective measures, plus a non-validated functional questionnaire Median±IQR scores for pain on palpation for group 1 at baseline was 49±26.2, 6 weeks 40±27.5, 3 months 35±24.8 and 6 months 21±20. Median±IQR scores for group 2 at baseline was 27±21.5, 6 weeks 20±20, 3 months 31±26 and 6 months 9±17.5. There was a significant decrease in pain on palpation in both treatment groups; no significant differences between groups were seen. |
*Information not within publication, authors contacted for clarification.
ROM, range of motion.