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Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy: study protocol for a randomised controlled trial.

Ingwersen KG, Christensen R, Sørensen L, Jørgensen HR, Jensen SL, Rasmussen S, Søgaard K, Juul-Kristensen B - Trials (2015)

Bottom Line: Shoulder pain is the third most common musculoskeletal disorder, often affecting people's daily living and work capacity.The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy.The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

View Article: PubMed Central - PubMed

Affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. kingwersen@health.sdu.dk.

ABSTRACT

Background: Shoulder pain is the third most common musculoskeletal disorder, often affecting people's daily living and work capacity. The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy. Exercise is often considered the primary treatment option for rotator cuff tendinopathy, but there is no consensus on which exercise strategy is the most effective. As eccentric and high-load strength training have been shown to have a positive effect on patella and Achilles tendinopathy, the aim of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy.

Methods/design: The current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with rotator cuff tendinopathy will be recruited from three outpatient shoulder departments in Denmark, and randomised to either 12 weeks of progressive high-load strength training or to general low-load exercises. Patients will receive six individually guided exercise sessions with a physiotherapist and perform home-based exercises three times a week. The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Discussion: Previous studies of exercise treatment for SIS have not differentiated between subgroups of SIS and have often had methodological flaws, making it difficult to specifically design target treatment for patients diagnosed with SIS. Therefore, it was considered important to focus on a subgroup such as tendinopathy, with a specific tailored intervention strategy based on evidence from other regions of the body, and to clearly describe the intervention in a methodologically strong study.

Trial registration: The trial was registered with Clinicaltrials.gov ( NCT01984203 ) on 31 October 2013.

No MeSH data available.


Related in: MedlinePlus

Anticipated outcome (primary and secondary objectives). A: (Primary objective) Illustration of expected DASH score at 12 weeks. Black = intervention group, White = control group. B: (Secondary objective) Illustration of expected DASH score at 12 weeks stratified for concomitant corticosteroid injection. Columns I + II = intervention group, Columns III + IV = control group, Black = concomitant corticosteroid injection, White = no concomitant corticosteroid injection. DASH, Disabilities of the Arm, Shoulder and Hand Questionnaire.
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Fig2: Anticipated outcome (primary and secondary objectives). A: (Primary objective) Illustration of expected DASH score at 12 weeks. Black = intervention group, White = control group. B: (Secondary objective) Illustration of expected DASH score at 12 weeks stratified for concomitant corticosteroid injection. Columns I + II = intervention group, Columns III + IV = control group, Black = concomitant corticosteroid injection, White = no concomitant corticosteroid injection. DASH, Disabilities of the Arm, Shoulder and Hand Questionnaire.

Mentions: Studies on patients with SIS have shown mean baseline values for DASH scores between 18 and 65, and standard deviations (SD) between 12 and 20 [30,31,43-47]. Often a 50% reduction in DASH score is seen after treatment [30,31,44,46,47], and it is suggested that a 40% change corresponds to a substantial improvement for the patient [46]. Based on these data, we expect a mean baseline of 40 points on the DASH questionnaire with an SD of 17. We expect a 50% change (change from 40 to 20 DASH points) in the progressive high-load exercise group, and 25% (change from 40 to 30 DASH points) in the low-load exercise group (Figure 2A).Figure 2


Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy: study protocol for a randomised controlled trial.

Ingwersen KG, Christensen R, Sørensen L, Jørgensen HR, Jensen SL, Rasmussen S, Søgaard K, Juul-Kristensen B - Trials (2015)

Anticipated outcome (primary and secondary objectives). A: (Primary objective) Illustration of expected DASH score at 12 weeks. Black = intervention group, White = control group. B: (Secondary objective) Illustration of expected DASH score at 12 weeks stratified for concomitant corticosteroid injection. Columns I + II = intervention group, Columns III + IV = control group, Black = concomitant corticosteroid injection, White = no concomitant corticosteroid injection. DASH, Disabilities of the Arm, Shoulder and Hand Questionnaire.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4318133&req=5

Fig2: Anticipated outcome (primary and secondary objectives). A: (Primary objective) Illustration of expected DASH score at 12 weeks. Black = intervention group, White = control group. B: (Secondary objective) Illustration of expected DASH score at 12 weeks stratified for concomitant corticosteroid injection. Columns I + II = intervention group, Columns III + IV = control group, Black = concomitant corticosteroid injection, White = no concomitant corticosteroid injection. DASH, Disabilities of the Arm, Shoulder and Hand Questionnaire.
Mentions: Studies on patients with SIS have shown mean baseline values for DASH scores between 18 and 65, and standard deviations (SD) between 12 and 20 [30,31,43-47]. Often a 50% reduction in DASH score is seen after treatment [30,31,44,46,47], and it is suggested that a 40% change corresponds to a substantial improvement for the patient [46]. Based on these data, we expect a mean baseline of 40 points on the DASH questionnaire with an SD of 17. We expect a 50% change (change from 40 to 20 DASH points) in the progressive high-load exercise group, and 25% (change from 40 to 30 DASH points) in the low-load exercise group (Figure 2A).Figure 2

Bottom Line: Shoulder pain is the third most common musculoskeletal disorder, often affecting people's daily living and work capacity.The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy.The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

View Article: PubMed Central - PubMed

Affiliation: Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark. kingwersen@health.sdu.dk.

ABSTRACT

Background: Shoulder pain is the third most common musculoskeletal disorder, often affecting people's daily living and work capacity. The most common shoulder disorder is the subacromial impingement syndrome (SIS) which, among other pathophysiological changes, is often characterised by rotator cuff tendinopathy. Exercise is often considered the primary treatment option for rotator cuff tendinopathy, but there is no consensus on which exercise strategy is the most effective. As eccentric and high-load strength training have been shown to have a positive effect on patella and Achilles tendinopathy, the aim of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy.

Methods/design: The current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with rotator cuff tendinopathy will be recruited from three outpatient shoulder departments in Denmark, and randomised to either 12 weeks of progressive high-load strength training or to general low-load exercises. Patients will receive six individually guided exercise sessions with a physiotherapist and perform home-based exercises three times a week. The primary outcome measure will be change from baseline to 12 weeks in the patient-reported outcome Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Discussion: Previous studies of exercise treatment for SIS have not differentiated between subgroups of SIS and have often had methodological flaws, making it difficult to specifically design target treatment for patients diagnosed with SIS. Therefore, it was considered important to focus on a subgroup such as tendinopathy, with a specific tailored intervention strategy based on evidence from other regions of the body, and to clearly describe the intervention in a methodologically strong study.

Trial registration: The trial was registered with Clinicaltrials.gov ( NCT01984203 ) on 31 October 2013.

No MeSH data available.


Related in: MedlinePlus