Ingwersen K.G.1,2, Jensen S.L.3, Sørensen L.4, Jørgensen H.R.5, Christensen R.6, Søgaard K.2, Juul-Kristensen B.2,7
1Lillebaelt Hospital - Vejle Hospital, Department of Rehabilitation, Vejle, Denmark, 2University of Southern Denmark, Department of Sports Science and Clinical Biomechanics, Odense, Denmark, 3Aalborg University Hospital - Farsø Hospital, Department of Orthopaedic Surgery, Shoulder Unit, Farsø, Denmark, 4Hospital Lillebaelt - Vejle Hospital, Orthopaedic Department, Shoulder Unit, Vejle, Denmark, 5Odense University Hospital - Svendborg Hospital, Orthopaedic Department, Shoulder Unit, Svendborg, Denmark, 6The Parker Institute, Musculoskeletal Statistics Unit, Copenhagen, Denmark, 7Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Department of Sports Science and Clinical Biomechanics, Bergen, Norway
Background: Shoulder pain is a frequent complaint in primary and secondary care. Subacromial impingement syndrome (SIS) is estimated to account for one third of all shoulder-related healthcare contacts. Rotator cuff (RC) tendinopathy is often used synonymously to SIS, but should be confined to patients with pain and weakness during elevation and external rotation, and largely preserved range of motion and minimal resting pain. Progressive high-load exercises have shown positive clinical effects in patients with patella and Achilles tendinopathy. For Rotator Cuff tendinopathy, the effects still need investigation.
Purpose: To assess the clinical effects of progressive high-load exercises (PHLE) compared with low-load exercises (LLE) in patients with rotator cuff tendinopathy.
Methods: In a randomised, participant- and assessor-blinded, controlled, multicentre superiority trial, stratified for concomitant administration of corticosteroid injection, patients with rotator cuff tendinopathy were recruited and randomised to either 12 weeks of PHLE or to LLE. Reported outcome measure was change from baseline to 12 weeks on a seven-point Global Perceived Effect (GPE) Likert pain scale, assessed in the As Observed population.
Results: 100 patients were randomised to either PHLE (49 patients) or to LLE (51 patients), the as observed population consisted of respectively 43 patients and 49 patients. No significant between group difference was found in the GPE Likert scale question In comparison to baseline, how is your shoulder pain now? (p=0.62). Within group, 55.8% in PHLE group and 57.1% in LLE group respectively, reported a minor, but important improvement in pain or an important improvement in pain. In contrast, 14.0% and 6.1% respectively, reported a small, but important worsening in pain.
Conclusion(s): Our results showed no superior benefit from traditional LLE over PHLE in patients with RC tendinopathy.
Implications: The results suggest that PHLE can safely be implemented in physiotherapy practice to patients diagnosed with rotator cuff tendinopathy, in shared decision-making between patients and therapists, to secure optimal compliance.
Funding acknowledgements: The Region of Southern Denmark's Research Fund, The Danish Rheumatism Association, and Danish Physiotherapy Associations Foundation funded the trial.
Topic: Musculoskeletal: peripheral
Ethics approval: The Regional Scientific Ethics Committee of Southern Denmark approved the trial on the 27 June, 2013 (project ID: S-20130071).
All authors, affiliations and abstracts have been published as submitted.
