The aim was to compare the after the 12-week and 1 year follow-up effects of a supervised specific exercise program in addition to usual care with a home exercise program on shoulder function in patients with stage II SIS. The secondary aim was to identify individual proportion of responders and non-responders for each outcome measure.
Ninety-four patients with stage II SIS were randomly allocated to supervised specific exercise program (n = 47) or a home exercise program (n = 47). The shoulder function was assessed using the Constant–Murley questionnaire. Upper limb function was assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; pain intensity with visual analog scale (VAS), kinesiophobia with the TSK-17; and response to treatment measured based on the level of irritability. All outcomes were assessed at baseline, after the 12-week intervention, and at the 1-year follow-up.
For the Constant–Murley, the between-group difference was 25.2 points at 12 weeks (p 0.001) and 31.5 points at 1 year (p 0.001) in favor of the supervised exercise group. These mean differences and their 95% confidence intervals exceeded the minimum clinically important difference of 17 points. For the secondary outcomes, at 12 weeks and 1 year DASH, VAS at movement, and TSK differences were statistically significant and clinically important in favor of the supervised exercise group. Moreover, at the end of the 12-week program, the percentage of participants showing a positive response was significantly higher in supervised exercise group compared with the home group (p 0.001).
In patients with stage II SIS after the 12-week intervention and at the 1-year follow-up, a supervised specific exercise program in addition to usual care was more effective than a home general exercise program. For all outcomes assessed, the differences between the groups exceeded the minimum threshold to be considered clinically important.
Our findings suggest that a supervised specific exercise program is particularly beneficial for patients with stage II SIS who had failed initial conservative treatment and who had high levels of irritability. Compared with the home general exercise group, the supervised exercise group showed a higher rate of responders to treatment and a better general response to treatment (lower levels of irritability). However, there are no previous similar studies to which we can compare our findings. We believe that it may be an important challenge for physical therapists to develop specific and individualized therapeutic exercise programs with gradual exposure to a load so that patients with chronic SIS can have a positive response to exercise. Therefore, we propose that clinicians and physiotherapists prescribe exercise programs based on the stage of tissue irritability.
Exercise therapy
Kinesiophobia
