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M.-O. Dubé1,2, J.-S. Roy1,2, F. Desmeules3,4, J. Lewis5
1Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada, 2Laval University, Rehabilitation Department, Quebec, Canada, 3Maisonneuve-Rosemont Hospital Research Center, Orthopedic Clinical Research Unit, Montreal, Canada, 4University of Montreal, School of Rehabilitation, Montreal, Canada, 5University of Hertfordshire, Hertfordshire, United Kingdom
Background: Rotator cuff related shoulder pain (RCRSP) is the most common shoulder disorder. Education and exercise are recommended interventions for the management of RCRSP. Despite this, 30% of people have no significant change in their symptoms, regardless of the intervention undertaken. This lack of effectiveness could be explained by a poor choice of exercise or other pain-related factors such as kinesiophobia, catastrophisation or pain self-efficacy. These prolonged symptoms need to be better managed as they can lead to detrimental consequences such as absenteeism from work, reduced quality of life and participation, and high associated healthcare costs.
Purpose: Compare the short, mid and long-term effects, in terms of symptoms and functional limitations, of 3 different ways (education, strengthening, motor control) of delivering shoulder management in individuals with RCRSP.
Methods: In this single-blind (assessor), parallel group randomized clinical trial, 83 adults presenting with RCRSP participated in a 12-weeks intervention program. They were randomly assigned to 1 of 3 groups (education, strengthening, motor control). Symptoms and functional limitations of all participants were evaluated at baseline and at 3, 6, 12 and 24 weeks using the QuickDASH. Baseline demographic data was compared (one-way ANOVA and Chi-squared tests) to establish the comparability of groups. A 2-way repeated-measures ANOVA (3 interventions [Control or Strengthening or Motor control] x 5 Time [0, 3, 6, 12 and 24 weeks]) was used to analyse and compare the effects of the three programs on the primary outcome.
Results: No statistical differences (p > 0.05) were found between groups for the baseline characteristics (age, height, weight, symptoms duration). There was statistically significant Time X Group Interaction (p < 0.05) showing a greater decrease on the QuickDASH scores for the motor control group (mean change: 28.0 ± 9.5) compared to education (15.2 ± 10.4) and strengthening (20.8 ± 9.1) groups.
Conclusion(s): The present results suggest that a motor control exercises program leads to better mid-to-long term outcomes in terms of symptoms and functional limitations than a strengthening exercises program or education only.
Implications: Production of recommendations for clinicians in order to decrease the percentage of individuals still showing significant symptoms following physiotherapy care for RCRSP.
Funding, acknowledgements: This work was supported by the Quebec Rehabilitation Research Network (REPAR). Marc-Olivier Dubé is supported by a FRQS training grant .
Keywords: Shoulder, Rotator cuff, Rehabilitation
Topic: Musculoskeletal: upper limb
Did this work require ethics approval? Yes
Institution: CIUSSS-CN
Committee: Sectorial Rehabilitation and Social Integration Research Ethics Committee
Ethics number: 2019-1762
All authors, affiliations and abstracts have been published as submitted.
