Ager AL1,2, Roy J-S2,3, Gamache F4, Hébert LJ2,5
1Gent University, Department of Rehabilitation Sciences, Gent, Belgium, 2Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Department of Rehabilitation Sciences, Quebec, Canada, 3Université Laval, Department of Rehabilitation Sciences, Quebec, Canada, 4Valcartier Garrison, Department of Physiotherapy, Courcelette, Canada, 5Université Laval, Department of Radiology/Nuclear Medicine, Quebec, Canada
Background: Shoulder pain is a leading complaint among musculoskeletal (MSK) injuries within a Western population, which also includes a military population, for which shoulder disorders are third in prevalence. A rotator cuff tendinopathy (RCt), the prevailing source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of motor control exercises for the management of a RCt, however the ideal method of delivery, a group setting versus one-on-one care, remains uncertain.
Purpose: To evaluate the effectiveness of a group-exercise approach with Canadian Armed Forces (CAF) soldiers affected by a RCt, compared to one-on-one care.
Methods: This single-blind (evaluator) pilot randomized clinical trial compared the effectiveness of two 6-week interventions, a novel group-supervised neuromuscular training program (UpEx-NTP) and one-on-one usual physiotherapy care (UPC), on the pain and symptoms of soldiers affected by a RCt. Thirty-one CAF soldiers with a RCt were randomly assigned to UpEx-NTP or UPC. The primary outcome was the Disabilities of Arm, Hand and Shoulder (DASH) questionnaire, while the Western Ontario Rotator Cuff (WORC) Index, shoulder strength, level of change (GROC scale), satisfaction and levels of pain (11-point Numerical Pain Rating Scale [NPRS]) were the secondary outcomes. Both groups were assessed at baseline (T0) and at 6 (T6) and 12 (T12) weeks. Analysis included 2-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses.
Results: No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p 0.001) and clinically significant improvements were observed for both groups with the DASH, WORC and NPRS, supporting that both groups improved over time.
Conclusion(s): Our preliminary data demonstrates that both rehabilitation approaches derived similar benefits over time. Suggesting, a group intervention for a RCt among soldiers has potential to be just as effective as a one-on-one approach, which may contribute to a decrease in waitlist time for access to care. This would be interesting to further explore among a civilian population with common MSK pathologies. Our research suggests potential for a group delivery method, and presents several lessons learned for the use of a group-supervised approach to facilitate treatment adherence. The development of the UpEx-NTP focused on motor (re)learning, scapular and postural re-education, and functional strengthening exercises. Considering the findings of our study, it appears that this program targeted the appropriate impairments for a shoulder RCt. Our recommendations include outlining realistic parameters and progressions for exercise prescription and specific patient goals, clearly explaining the benefit of each exercise and implementing comprehensive monitoring and correcting during the group program.
Implications: Our research supports further investigation into the cost and clinical resource benefits of a supervised group-approach for common MSK conditions, to facilitate creative solutions to improve access to rehabilitative care within an increasingly strained medical system.
Keywords: Group intervention, rotator cuff tendinopathy, motor control exercises
Funding acknowledgements: IRDPQ / OPPQ Québec. Program 4.2.1 (Canada). CIRRIS / IRDPQ and Université Laval, Student Bursary (Québec, Canada).
Purpose: To evaluate the effectiveness of a group-exercise approach with Canadian Armed Forces (CAF) soldiers affected by a RCt, compared to one-on-one care.
Methods: This single-blind (evaluator) pilot randomized clinical trial compared the effectiveness of two 6-week interventions, a novel group-supervised neuromuscular training program (UpEx-NTP) and one-on-one usual physiotherapy care (UPC), on the pain and symptoms of soldiers affected by a RCt. Thirty-one CAF soldiers with a RCt were randomly assigned to UpEx-NTP or UPC. The primary outcome was the Disabilities of Arm, Hand and Shoulder (DASH) questionnaire, while the Western Ontario Rotator Cuff (WORC) Index, shoulder strength, level of change (GROC scale), satisfaction and levels of pain (11-point Numerical Pain Rating Scale [NPRS]) were the secondary outcomes. Both groups were assessed at baseline (T0) and at 6 (T6) and 12 (T12) weeks. Analysis included 2-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses.
Results: No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p 0.001) and clinically significant improvements were observed for both groups with the DASH, WORC and NPRS, supporting that both groups improved over time.
Conclusion(s): Our preliminary data demonstrates that both rehabilitation approaches derived similar benefits over time. Suggesting, a group intervention for a RCt among soldiers has potential to be just as effective as a one-on-one approach, which may contribute to a decrease in waitlist time for access to care. This would be interesting to further explore among a civilian population with common MSK pathologies. Our research suggests potential for a group delivery method, and presents several lessons learned for the use of a group-supervised approach to facilitate treatment adherence. The development of the UpEx-NTP focused on motor (re)learning, scapular and postural re-education, and functional strengthening exercises. Considering the findings of our study, it appears that this program targeted the appropriate impairments for a shoulder RCt. Our recommendations include outlining realistic parameters and progressions for exercise prescription and specific patient goals, clearly explaining the benefit of each exercise and implementing comprehensive monitoring and correcting during the group program.
Implications: Our research supports further investigation into the cost and clinical resource benefits of a supervised group-approach for common MSK conditions, to facilitate creative solutions to improve access to rehabilitative care within an increasingly strained medical system.
Keywords: Group intervention, rotator cuff tendinopathy, motor control exercises
Funding acknowledgements: IRDPQ / OPPQ Québec. Program 4.2.1 (Canada). CIRRIS / IRDPQ and Université Laval, Student Bursary (Québec, Canada).
Topic: Musculoskeletal: upper limb; Disability & rehabilitation
Ethics approval required: Yes
Institution: L'Institut de réadaptation en déficience physique de Québec (IRDPQ)
Ethics committee: Comité d’éthique de la recherche de l’IRDPQ (Québec, Canada):
Ethics number: 2015-446
All authors, affiliations and abstracts have been published as submitted.
