HEAVY SHOULDER STRENGTHENING EXERCISES IN PATIENTS WITH HYPERMOBILITY SPECTRUM DISORDER AND PERSISTENT SHOULDER PROBLEMS: A FEASIBILITY STUDY

B. Liaghat¹, S.T. Skou^1,2, U. Jørgensen³, J. Sondergaard⁴, K. Søgaard^5,6, B. Juul-Kristensen¹

Background: Patients with hypermobility spectrum disorder (HSD) are in great risk of experiencing shoulder problems, but evidence for treatment is sparse.

Purpose: The purpose of this study was to evaluate the feasibility of heavy shoulder strengthening exercise in patients with HSD and persistent shoulder problems to inform a randomised controlled trial (RCT).

Methods: This was a feasibility study. Patients were recruited from April to July 2018 in primary care by general practitioners and physiotherapy clinics from the Region of Southern Denmark. Twelve patients (39.3±13.9 years, 91.7% females) with HSD and shoulder instability and/or pain for more than 3 months were included. The intervention included a 16-week progressive heavy shoulder strengthening exercise programme 3 times per week using exercises targeting scapular and rotator cuff muscles. The primary outcomes were pre-defined progression criteria including recruitment rate (acceptable: 6 patients/month), assessment duration (acceptable: <120 min), patient retention (acceptable: >80% complete intervention), training adherence (acceptable: >75% adhere equal to >36 training sessions), adverse events (acceptable: minor events with no patients discontinuing the study), besides positive patient and physiotherapist feedback. Secondary outcomes were the Western Ontario Shoulder Instability Index questionnaire (WOSI (0-2100, better to worse)); treatment impact on other patient-reported health parameters, such as pain, fatigue and kinesiophobia; isometric shoulder strength; and clinical tests for shoulder instability/laxity, and proprioception.

Results: Recruitment rate was 5.6/month, assessment duration (mean±SD) 105±9 min, retention 100%, adherence 83%, and four patients experienced mild and transient soreness/pain. Patient feedback was positive, and physiotherapists found the intervention relevant and applicable to the patient group. The WOSI total score improved by 51% (mean±SD, points: baseline 1037±215; follow-up 509±365; mean change (95%CI), 528 (318;738)), and patients reported reduced pain, kinesiophobia, and fatigue. Shoulder strength measurements improved by 28-31% (mean change (95%CI), Nm/kg: scaption 0.51 (0.23;0.78); internal rotation 1.32 (0.70;1.95); and external rotation 0.89 (0.37;1.40)), clinical shoulder tests indicated partly decreased laxity, but no change in shoulder proprioception.

Conclusion(s): The shoulder strengthening exercise programme is feasible in patients with HSD and persistent shoulder problems.

Implications: An RCT, with adjusted and improved recruitment strategy, has been initiated and will soon finish the recruitment of 100 participants, as determined by the sample size calculations.  These data will demonstrate whether the exercise programme is effective in improving symptoms, function, and quality of life in this patient group.

Funding, acknowledgements: Region of Southern Denmark; Esbjerg municipality; Danish Rheumatism association; Fund for Research, Quality, and Education in Physiotherapy Practice; SDU.

Keywords: Hypermobility, Shoulder, Exercise

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? Yes

Institution: Region of Southern Denmark

Committee: Regional Committees on Health Research Ethics for Southern Denmark

Ethics number: S-20170066