Shoulder Pain Clinical Trial
Official title:
Treatment of Subacromial Shoulder Pain by Individual or Group Physiotherapy Following Corticosteroid Injection
The aim of this study is therefore to examine the clinical effectiveness and provide an economic analysis of individual versus group physiotherapy, following corticosteroid injection, for management of Subacromial Impingement (SAI) of the shoulder.
This trial was a single blind, randomised, equivalence trial comparing rotator cuff
rehabilitation classes with traditional individual physiotherapy in subacromial impingement
of the shoulder. A total of 200 patients were planned to be recruited from patients with
painful shoulder referred to the Ulster Community and Hospitals Trust and community
physiotherapy at the Ulster, Ards and Bangor sites or injection clinics at the Ulster
Hospital. Local General Practitioners were also informed of the study and invited to refer
appropriate patients.
Intervention - Triamcinolone 40 mg (1 ml) and 6 weekly rotator cuff rehabilitation classes
Control - Triamcinolone 40 mg (1 ml) and routine physiotherapy 6 sessions weekly for 6 weeks
The injection technique involving a lateral approach to the subacromial space was used. An
interval of between 1 and 3 weeks was allowed between injection and commencement of classes
or physiotherapy.
Classes were planned to be run by a rotating group of physiotherapists with at least 1 year
of musculoskeletal outpatient's experience. They were to receive instruction on the protocol
to use in the classes. Classes were to consist of six 30 min sessions on a weekly basis. A
minimum of 5 and maximum of 10 participants were to attend. Advice was to be given on the
nature of the condition. Subjects were to be instructed and supervised in exercises for
scapulo-humeral mobility, scapulo-humeral stability and specific rotator cuff rehabilitation
exercises. Subjects were to be introduced to ongoing classes as they are recruited to the
trial.
Six sessions of routine physiotherapy at weekly intervals were to be undertaken. Treatment
was to be based on evidence-based guidelines for the treatment of shoulder impingement
(Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy
management of shoulder impingement syndrome Chartered Society of Physiotherapists 2005) and
consist of mobilisation techniques and supervised exercises and stretches. A therapist with
at least 1 year of musculoskeletal outpatients experience was to provide treatments.
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