Ms Rita Kinsella
|Recipient:||Ms Rita Kinsella|
|Intended department:||Physiotherapy Department-St Vincent’s Hospital Melbourne/La Trobe- Funded by Zimmer Biomet|
|Isometric Exercises for rehabilitation of rotator cuff tendinopathy/ subacromial pain syndrome|
Shoulder disorders are a leading cause of pain and disability in our society with one in three people experiencing shoulder pain at some stage in their lives. Recurrence is common and symptoms are often persistent. The rotator cuff muscles are considered the prime source of symptoms with a diagnosis of rotator cuff tendinopathy/subacromial pain syndrome (SPS) accounting for approximately 30% of all diagnoses made by GPs. SPS is associated with substantial economic costs at both the individual and societal level.
Despite widespread use of injection therapies and increasing resort to surgical procedures, evidence suggests that physiotherapy involving a structured exercise program is the most efficacious in the management of patients with this disorder, associated with fewer risks and lower health costs. It is therefore increasingly advocated that a course of physiotherapy be undertaken before surgery is considered. Within this, exercises that address movement patterns about the shoulder complex as well as strengthening the rotator cuff muscles, have been suggested to be the most effective in this disorder. However, there remains limited evidence on the specifics of this, particularly in terms of the type of rotator cuff strengthening exercises used.
The funding made available from Arthritis Australia (Zimmer Biomet Award) was used to design and implement the SPaRC trial. The purpose of this pilot study was to compare the effects of three different rehabilitation programs in patients diagnosed with SPS to see whether one or other produced faster gains in pain and strength and therefore return to function, for patients diagnosed with this painful and often debilitating disorder. The three groups undertook a similar exercise program except the specific mode of rotator cuff strengthening exercises varied between the three groups.
It was considered important to establish feasibility using a pilot trial design before undertaking a large full-scale study. Therefore, the primary aim of the pilot RCT was to evaluate key study feasibility parameters relating to ease of recruitment, adherence and compliance with the various components of the study, dropout rates and, (serious) adverse events. The secondary aim was to offer insights into any potential trends in treatment effects observed between the groups, to explore whether faster gains in pain, strength and therefore function were achieved from either of the three exercise interventions being investigated.
Diagnosis of this disorder is difficult with no one test able to differentiate SPS from other common shoulder conditions such as frozen shoulder or instability. A specific algorithm was developed, in an attempt to ensure appropriate participants were included, with both telephone and face-to-face assessments undertaken. To date, out of a possible 34 participants screened, 12 participants have been randomised to the study. Recruitment has therefore been slower than hoped. However, adherence to the study has been excellent, with all participants to date, completing all study protocols.
The intervention involved 5-8 face to face treatment sessions with the physiotherapist, primarily using an exercise-based approach. Participants were assessed at baseline, week 6, week 12 and 6 months to observe any differences in change scores between the groups. The effects on the entire cohort as a group were also observed. Participants were required to complete questionnaires relating to pain and function, and physical measures were undertaken including shoulder strength testing.
The SPaRC trial is on-going, with just over a third of participants recruited to date.
Preliminary results are promising and although it is too soon to determine between-group differences, there is a definite trend that the participants to date have benefited from the intervention, with improvements in pain and function well above the established minimal clinically important differences for the patient reported outcomes used. Of the 10 participants who have so far undertaken the 3 month post-treatment assessment, median change scores for the Shoulder Pain and Disability Index (SPADI), the Western Ontario Rotator Cuff Index (WORC) and Numerical Rating Scale for Pain (average pain, night pain and pain on shoulder activity) were significantly improved from baseline and eight out of the ten reported feeling “much better” on the Global Rating of Change Scale (GRCS) than prior to the start of the treatment.
Further recruitment drives will ensure that full participant recruitment is achieved with final analysis providing further direction for the implementation of a larger scale trial.
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