Effectiveness of Pulse Electromagnetic Field Therapy in Patients With Subacromial Impingement Syndrome: A Double-Blind Randomized Sham Controlled Study.

OBJECTIVES: To evaluate the 3-month effects of pulsed electromagnetic field therapy (PEMF) in the treatment of subacromial impingement syndrome (SIS). DESIGN: Planned analysis of a randomized controlled trial with 4- and 12-week follow-ups. SETTING: Physical medicine and rehabilitation clinic, treatment unit. PARTICIPANTS: Of the 250 individuals screened for eligibility, participants with a diagnosis of SIS (N=80) were randomized to intervention or control groups. INTERVENTION: The first group received PEMF + exercise and the second group received sham PEMF + exercise 5 days a week for a total of 20 sessions. MAIN OUTCOME MEASURES: Visual Analog Scale (VAS), Constant Murley Score (CMS), Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) Quality of Life Questionnaire, and shoulder muscle strength measurement with an isokinetic dynamometer. Evaluations were performed before treatment (T0), after treatment (T1), and 12th week (T2). RESULTS: Evaluation at T1 and T2 showed improvement in most parameters in both groups compared with baseline. In the comparison between the 2 groups at T1 and T2, more improvement was found in the PEMF group in most parameters. CONCLUSIONS: In our study, PEMF was found to be superior to sham PEMF in terms of pain, ROM, functionality, and quality of life at the first and third months.

Factors predicting long-term outcomes following physiotherapy in patients with subacromial pain syndrome: a secondary analysis.

BACKGROUND: Although patients with shoulder complaints are frequently referred to physiotherapy, putative predictive factors for outcomes are still unclear. In this regard, only a limited amount of scientific data for patients with subacromial pain syndrome exist, with inconsistent results. An improved knowledge about the ability of baseline variables to predict outcomes could help patients make informed treatment decisions, prevent them from receiving ineffective treatments, and minimize the risk of developing chronic pain. AIM: The aims of this secondary longitudinal analysis are threefold: First, to investigate baseline differences between patients with and without successful long-term outcomes following physiotherapy. Second, to compare the predictive ability of two sets of putative predictive variables on outcomes, one based on the literature and one based on the data of the original trial. Third, to explore the contribution of short-term follow-up data to predictive models. METHODS: Differences between responders and nonresponders were calculated. The predictive ability of variables defined through literature and of variables based on the Akaike Information Criterion (AIC) from the original trial dataset on the Shoulder Pain and Disability Index and the Patients' Global Impression of Change at the one-year follow-up were analyzed. To test the robustness of the results, different statistical models were used. To investigate the contribution of follow-up data to prediction, short-term data were included in the analyses. RESULTS: A sample of 87 patients with subacromial pain syndrome was analyzed. 77% (n = 67) of these participants were classified as responders. Higher expectations and short-term change scores were positive, and higher fear avoidance beliefs, greater baseline disability and pain levels were negative predictors of long-term outcomes in patients with subacromial pain syndrome. CONCLUSIONS: Although our results are in line with previous research and support the use of clinical factors for prediction, our findings suggest that psychological factors, especially patient expectations and fear avoidance beliefs, also contribute to long-term outcomes and should therefore be considered in the clinical context and further research. However, the hypotheses and recommendations generated from our results need to be confirmed in further studies due to their explorative nature. TRIAL REGISTRATION: The original trial was registered at Current Controlled Trials under the trial registration number ISRCTN86900354 on March 17, 2010.

A Comparison of 2 Exercise Protocols in Athletes With Primary Subacromial Impingement Syndrome: A Randomized Clinical Trial.

CONTEXT: To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. DESIGN: A randomized and controlled clinical study. METHODS: Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. RESULTS: The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). CONCLUSIONS: The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.

Supervised Training Compared With No Training or Self-training in Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-analysis.

OBJECTIVE: To study the effects of supervised training in adults with subacromial pain syndrome. DATA SOURCES: Embase, MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database were searched from inception to March 2020. STUDY SELECTION: Independent reviewers selected randomized controlled trials comparing supervised training with (1) no training or (2) self-training in adults with subacromial pain syndrome lasting for at least 1 month. Critical outcomes were shoulder pain, function, and patient-perceived effect. Important outcomes included other potential benefits and adverse events at 3-month follow-up. DATA EXTRACTION: Two independent reviewers extracted data for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias tool 1, and certainty of evidence was evaluated using the Grades of Recommendation Assessment, Development, and Evaluation (GRADE). DATA SYNTHESIS: Ten studies (n=597, 43% female) were included. Supervised training resulted in larger improvements than no training on pain (at rest: n=286; mean difference [MD], 1.68; 95% confidence interval [CI], 0.31-3.06 on 0-10 scale; during movement: n=353; MD, 1.84; 95% CI,0.91-2.76), function (n=396; standardized MD, 0.30; 95% CI, 0.07-0.52), and patient-perceived effect (n=118; risk ratio, 1.43; 95% CI, 0.87-2.34). Supervised training had potential benefits regarding quality of life, return to work, dropout, and training adherence, albeit more patients reported mild, transient pain after training. Supervised training and self-training showed equal improvements on pain (n=44) and function (n=76), with no data describing patient-perceived effect. Certainty of evidence was low for critical outcomes and low-moderate for other outcomes. CONCLUSIONS: Supervised training might be superior to no training and equally effective as self-training on critical and important outcomes. Based on low-moderate certainty of evidence, these findings support a weak recommendation for supervised training in adults with subacromial pain syndrome.

Comparing the effects of no intervention with therapeutic exercise, and exercise with additional Kinesio tape in patients with shoulder impingement syndrome. A three-arm randomized controlled trial.

OBJECTIVE: To investigate if adding Kinesio tape to therapeutic exercise is an effective treatment to improve clinical outcomes compared to therapeutic exercise alone and no intervention, in patients with shoulder impingement syndrome. DESIGN: Three-arm randomized controlled trial. SETTING: Outpatient setting. SUBJECTS: One hundred and twenty patients (mean (SD): age 37.8 (5.4)) with shoulder impingement syndrome. INTERVENTION: Patients were randomly assigned to eight-weeks therapeutic exercise alone, therapeutic exercise with Kinesio tape, and control group. MAIN MEASURES: Pain was measured with a numerical rating scale and disability and scapular kinematics were measured with a relative questionnaire and motion analysis software respectively, at baseline and after eight-weeks intervention. RESULTS: There was significant differences in therapeutic exercise with Kinesio tape group vs. therapeutic exercise alone and control group respectively for pain (d = -0.34, P = 0.042; and d = -1.53, P = 0.001), disability (d = -0.46, P = 0.024; and d = -2.18, P = 0.001), scapular upward rotation at sagittal plane (d = 0.33, P = 0.033; and d = 0.68, P = 0.001), scapular plane (d = 0.18, P = 0.045; and d = 0.43, P = 0.001), scapular tilt at sagittal plane (d = 0.55, P = 0.043; and d = 1.39, P = 0.001), and scapular plane (d = 0.29, P = 0.034; and d = 0.58, P = 0.001). Therapeutic exercise alone was superior over control group in all significant outcomes (P < 0.05). CONCLUSION: Although therapeutic exercises alone showed positive effect on clinical outcomes, adding Kinesio tape to therapeutic exercises had more significant effects with larger effect sizes. Adding Kinesio tape to therapeutic exercise may be of some assistance to clinicians in improving clinical outcomes in patients with shoulder impingement syndrome.

Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: A randomised controlled trial.

OBJECTIVE: To investigate the effect of low-level laser therapy (LLLT) combined with exercise on shoulder pain and disability in patients with subacromial impingement syndrome (SIS). DESIGN: Randomised controlled trial. SETTING: Pontifical Catholic University. SUBJECTS: We enrolled 120 subacromial impingement syndrome patients. INTERVENTION: Groups I (n = 42), II (n = 42) and III (n = 36) were treated with Low-level laser therapy and exercise, exercise only and Low-level laser therapy only, respectively. Interventions were conducted three times a week for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome was the change in shoulder pain and disability index (SPADI). Secondary outcomes included changes in the numeric pain rating scale and medication intake. RESULTS: Average ages of patients in groups I, II and III were 51.9 ± 8.7 years, 56.0 ± 10.4 years and 54.2 ± 7.1 years, respectively. Pain scores at baseline (P = 0.829), 2 months (P = 0.057) and 3 months follow-ups (p = 0.004) were 6.8 (4.7-7.7), 0.2 (0.0-0.5) and 0.3 (0.0-1.0) for group I; 6.6 (5.7-8.0), 0.5 (0.2-2.0) and 0.2 (0.0-3.3) for group II; and 6.5 (5.1-7.4), 2.4 (0.1-6.7) and 4.0 (2.0-5.0) for group III, respectively. SPADI scores at baseline (P = 0.029), 2 months (P < 0.001) and 3 months follow-ups (P = 0.001) were 60.8 (37.7-70.8), 3.8 (0.0-10.8) and 2.3 (0.8-10.8) for group I; 61.5 (41.5-71.5), 9.2 (3.8-29.2) and 14.2 (1.5-38.0) for the group II; and 73.3 (59.2-80.8), 34.2 (16.9-54.6) and 33.1 (22.3-49.2) for the group III, respectively. CONCLUSION: Low-level laser therapy combined with exercises reduce pain intensity, improve shoulder function and reduces pain intensity and medication intake over 3 months. CLINICAL TRIAL REGISTRATION NUMBER: NCT02725749.

Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial.

OBJECTIVES: To assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison). METHODS: We conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35-65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry. RESULTS: In the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were -2.0 (95% CI -8.5 to 4.6; p=0.56) at rest and -8.0 (-17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (-5.6 to 7.6; p=0.77) at rest and -3.9 (-12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events. CONCLUSIONS: ASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.

Feedback improves the scapular-focused treatment effects in patients with shoulder impingement syndrome.

PURPOSE: This study aimed to evaluate the effects of scapular-focused treatment with (SFTF) and without (SFT) feedback on pain, function, and scapular kinematics in patients with Shoulder Impingement Syndrome (SIS). METHODS: Seventy-five males and females with SIS were randomly assigned into SFTF (n = 25), SFT (n = 25) and control (n = 25) groups. The primary outcome was pain, assessed by Visual Analog Scale (VAS). The secondary outcomes were function and scapular kinematics, assessed by DASH Questionnaire and a 3-D motion capture, respectively. All outcomes were measured at the baseline and after the 8-week interventions. RESULTS: A post hoc analysis performed to show significant differences between groups after the 8-week interventions. For pain, there were significant differences between SFTF vs. SFT (ES (95% CI) = - 0.3(- 0.4 to - 0.1); P = 0.04), SFTF vs. control (ES (95% CI) = 1.3(0.7-1.9); P = 0.01). For DASH, also, there were significant differences between SFTF vs. SFT (ES (95% CI) = 1.8(1.1-2.4); P = 0.03), SFTF vs. control (ES (95% CI) = 4.4(3.3-5.4); P = 0.01), and SFT vs. control (ES (95% CI) = 2.6(1.8-3.4); P = 0.01). For scapular internal rotation (the sagittal or scapular planes), scapular upward rotation, and the scapular tilt, however, there were no differences between SFTF vs. SFT. CONCLUSION: Based on the study results, a rehabilitation program integrated with verbal feedbacks is effective to relieve pain, and improve function and scapular kinematics in patients with SIS. Adding feedback to an exercise therapy could clinically enhance outcomes in patients with SIS. LEVEL OF EVIDENCE: Level II. TRIAL REGISTRATION: This study was prospectively registered at UMIN-CTR website, and the unique trail number is UMIN000036399.

Efficacy of throwing exercise with TheraBand in male volleyball players with shoulder internal rotation deficit: a randomized controlled trial.

BACKGROUND: The Glenohumeral internal-rotation deficit (GIRD) is related to the altered eccentric external-rotator (ER), the concentric internal-rotator (IR), muscle strength, and the ER: IR ratio. GIRD has been documented as a risk factor for shoulder injuries. However, few studies have investigated the effect of an exercise training on these parameters in athletes with GIRD. Therefore, the purpose of this study was to evaluate the effects of an 8-week throwing exercise with a TheraBand for retraining the rotator cuff on Electromyography (EMG) activity of selected muscles, rotator cuff muscle strength, the glenohumeral (GH) joint IR range of motion (ROM) and GH joint position sense in asymptomatic male volleyball players with GIRD. METHODS: Sixty male volleyball players with GIRD were randomized into either a training group or a control group. The experimental group underwent an 8-week throwing exercise with a TheraBand including 5 sessions of stretching and 3 sessions of strengthening exercises per week. The control group received an active self-exercise program. EMG (onset time and muscle activation), shoulder range of motion (ROMs), strength and GH joint position sense were all assessed pre and post trainings. RESULTS: There were statistically significant within-group differences in the EMG activity of the anterior deltoid (p = 0.005), middle deltoid (p = 0.007), posterior deltoid (p = 0.004), infraspinatus (p = 0.001) and supraspinatus (p = 0.001) muscles, IR ROM (p = 0.001), rotator cuff muscle strength ratio (p = 0.001), and GH joint position sense (p = 0.033) in the experimental group. A 2 × 2 analysis of variance with a mixed model design and independent and paired t-tests were used for statistical analysis. CONCLUSIONS: Throwing exercise with a TheraBand improved shoulder muscle activation, IR ROM, rotator cuff muscle strength ratio and GH joint position sense in participants with GIRD. These findings may improve the treatment of GIRD in a clinical setting. Although the results are significant, further studies should follow up the long-term effects of the Throwing exercise with a TheraBand on GIRD. TRIAL REGISTRATION: Current Controlled Trials using the UMIN-RCT website with ID number of, UMIN000038416 "Retrospectively registered" at 2019/10/29.

[Influence of Patients' Profession on Therapeutical Outcome of Patients with Primary Extrinsic Shoulder Impingement]. / Einfluss der beruflichen Tätigkeit auf den Therapieerfolg von Patienten mit primär extrinsischem Impingement der Schulter.

PURPOSE: Shoulder complaints are an important reason for inability to work. There are few considerations that link the effect of kind of therapy with ability to work in connection with kind of employment. This prospective, comparative clinical follow-up study examines the influence of occupational activity with conservative and operative therapy on the outcome of therapy in terms of function, pain and ability to work. METHODS: In this study, 97 patients (women: n=22, men: n=75, mean age: 43.1±10.1 years) with a primary extrinsic shoulder impingement syndrome were included. Patients were divided into blue and white collar workers. Further on the subgroups of conservative and operative therapy were considered. Either a sole conservative therapy or an operative therapy with physiotherapeutic follow-up treatment took place. The conservative therapy was carried out as a structured re-coordination of muscles of the shoulder girdle under supervision of a physiotherapist. In the surgical cohorts an arthroscopic subacromial decompression was performed. Follow-up examinations were passed 3, 6 and 12 months after starting the intervention. Function (Constant Score), pain (NRS) and the duration of inability to work were assessed. The statistical analysis was performed using mixed-design ANOVA to calculate main effect and interactions (therapy*kind of employment*time) adjusted with age, sex and body mass index. RESULTS: There was no statistically significant difference in terms of function and pain between blue and white collar workers. Office workers showed a significantly longer inability to work 3 months after surgical treatment compared with conservative treatment (7.3±0.8 weeks vs. 0.5±7.3 weeks; p<0.001). Further the group of white collars with operative therapy was significantly longer inable to work than the group of blue collar workers after operative therapy 3 months after surgical treatment (3.0±1.1 weeks vs. 7.3±0.8 weeks; p=0.002). CONCLUSION: On the one hand, working in an office could be seen as a negative predictor for durance of inability to work. On the other hand, surgical treatment itself was a negative predictor for the durance of inability to work. Furthermore, no difference between conservative and surgical therapy could be observed in function and pain one year after starting the treatment.

Effect of shoulder stability exercises on hand grip strength in patients with shoulder impingement syndrome.

Background: Shoulder impingement syndrome (SIS) is the second most common musculoskeletal condition that causes shoulder pain in the general population. Shoulder girdle muscle imbalance and posterior capsule tightness have been implicated as contributing factors. Objective: The purpose of this study was to investigate the effect of shoulder stability exercises (SSEs) on hand grip strength in patients with unilateral SIS. Methods: A total of 16 patients with a mean age of 32 ± 9.3 years diagnosed with stage II unilateral SIS participated in this study. A standardized SSE programme was conducted in the clinic under the direct 1-to-1 supervision of a physical therapist thrice weekly for 4 weeks for a total of 12 sessions on the affected and non-affected shoulders. The effect of the SSE programme on isometric hand grip strength was analysed. Results: A significant difference (p = .016) was observed in the hand grip strength of the affected shoulder side before and after the intervention, but no significant difference (p = 1.0) was found in the hand grip strength of the non-affected shoulder side post-intervention. Conclusion: The reduction in isometric hand grip strength of the affected shoulder side compared to that of the non-affected shoulder side in the same subject before the intervention shows that SIS significantly affects the hand grip strength of the affected side. SSEs significantly affect the isometric hand grip strength of SIS patients.

Effects of eccentric exercise in patients with subacromial impingement syndrome: a systematic review and meta-analysis.

BACKGROUND: Subacromial impingement syndrome is a common problem in primary healthcare. It often include tendinopathy. While exercise therapy is effective for this condition, it is not clear which type of exercise is the most effective. Eccentric exercises has proven effective for treating similar tendinopathies in the lower extremities. The aim of this systematic review was therefore to investigate the effects of eccentric exercise on pain and function in patients with subacromial impingement syndrome compared with other exercise regimens or interventions. A secondary aim was to describe the included components of the various eccentric exercise regimens that have been studied. METHODS: Systematic searches of PubMed, Cochrane Library and PEDro by two independent authors. Included studies were assessed using the PEDro scale for quality and the Cochrane scale for clinical relevance by two independent authors. Data were combined in meta-analyses. GRADE was applied to assess the certainty of evidence. RESULTS: Sixty-eight records were identified. Seven studies (eight articles) were included, six were meta-analysed (n = 281). Included studies were of moderate quality (median PEDro score 7, range 5-8). Post-treatment pain was significantly lower after eccentric exercise compared with other exercise: MD -12.3 (95% CI - 17.8 to - 6.8, I2 = 7%, p < 0.001), but this difference was not clinically important. Eccentric exercise provided no significant post-treatment improvement in function compared with other exercise: SMD -0.10 (95% CI - 0.79 to 0.58, I2 = 85%, p = 0.76). Painful eccentric exercise showed no significant difference compared to pain-free eccentric exercise. Eccentric training regimes showed both similarities and diversity. Intervention duration of 6-8 weeks was almost as effective as 12 weeks. CONCLUSIONS: Evidence of low certainty suggests that eccentric exercise may provide a small but likely not clinically important reduction in pain compared with other types of exercise in patients with subacromial impingement syndrome. It is uncertain whether eccentric exercise improves function more than other types of exercise (very low certainty of evidence). Methodological limitations of existing studies make these findings susceptible to change in the future. TRIAL REGISTRATION: PROSPERO CRD42019126917 , date of registration: 29-03-2019.

A Systematic Review and Meta-analysis of Functional Shoulder Impairment After Latissimus Dorsi Breast Reconstruction.

PURPOSE: The latissimus dorsi flap (LDF) is a very reliable flap and may be used for a multitude of reconstructive purposes. It is widely used for breast reconstruction when performed. It has few complications, except for a possible impact on shoulder function. The aims of this study were to evaluate the validity of the literature by investigating the level of evidence and to perform a meta-analysis. METHODS: A systematic literature search was conducted using the databases PubMed, Scopus, and Web of Science. Predictor variables were shoulder function after breast reconstruction with the LDF. Articles were chosen according to 4 different outcomes: shoulder range of motion (ROM), shoulder strength, DASH score, and subjective evaluation. RESULTS: Twenty-six articles were found, including 1045 patients: 8 level II, 16 level III, 1 level IV, and 1 level V articles. The meta-analysis showed that both ROMs for flexion and abduction are significantly impaired at less than or at 3 months of follow-up. CONCLUSIONS: There are several influencing factors, such as age, smoking, obesity, radiotherapy, and physiotherapy. Moreover, the impact on shoulder function seemed influenced by the type of thoracodorsal vessel-based flap. From the level of evidence analysis, there is a tendency that the LDF transfer does affect shoulder function. This limitation seems to be minimal, and few patients experience a major impact on shoulder function. However, the existing literature on total shoulder impairment after breast reconstruction with LDF is insufficient to draw any final conclusion. There is a need for future studies and current articles that suggest that the initial measurement should be performed preoperatively (preferably at the time of diagnosis or initial biopsy) and follow-ups with measurements at 6, 12, and 24 months (long-term effect) after surgery. We recommend measurements of both operated and nonoperated sides. Each measurement should be accompanied by a history with special emphasis on shoulder function. The methods of measuring outcomes of recommendation are DASH score, ROM with use of a goniometer preferably by a physiotherapist or a health care professional trained by a physiotherapist, and strength measured by, for example, a handheld dynamometer.

A RGBD-Based Interactive System for Gaming-Driven Rehabilitation of Upper Limbs.

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient's performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.

General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings.

BACKGROUND: To explore patient characteristics predictive of a poor response to multidisciplinary non-surgical rehabilitation of three common orthopaedic conditions within a tertiary care service. METHODS: A retrospective audit of medical records of patients who had undergone multidisciplinary non-surgical management of their knee osteoarthritis (KOA, n = 190), shoulder impingement syndrome (SIS, n = 199), or low back pain (LBP, n = 242) within a multisite tertiary care service was undertaken. Standardised clinical measures recorded by the service at the initial consultation were examined using a base binary logistic regression model to determine their relationship with a poor response to management (ie. not achieving a minimal clinically important improvement in the condition disability measure pre-post management). RESULTS: Factors predictive of a poor response following non-surgical management included;; higher levels of anxiety (OR 1.11, P < 0.02) and lower functional score (OR 0.76, P < 0.04) for KOA, higher number of comorbidities (OR 1.16, P < 0.03) for SIS, and coexisting cervical or thorax pain (OR 2.1, P = 0.04) and lower pain self-efficacy (OR 0.98, P = 0.02) for LBP. CONCLUSIONS: General health issues may present a barrier to achieving favourable outcomes in response to multidisciplinary non-surgical rehabilitation for the management of common orthopaedic conditions in a tertiary care setting. Clinicians may need to consider these broader patient issues when designing management strategies for patients with these conditions.

Pain, motion and function comparison of two exercise protocols for the rotator cuff and scapular stabilizers in patients with subacromial syndrome.

STUDY DESIGN: Randomized clinical trial. INTRODUCTION: Eccentric exercise (EE) was shown to be an effective treatment in tendinopathies. However, the evidence of its effectiveness in subacromial syndrome (SS) is scarce. Moreover, consensus has not been reached on whether best results for SS are obtained by means of EE with or without pain. PURPOSE OF THE STUDY: The purpose of this is to compare the effect on pain, active range of motion (AROM), and shoulder function of an exercise protocol performed with pain <40 mm Visual Analog Scale (VAS) and without pain, in patients with SS. METHODS: Twenty-two subjects (mean age: 59 years [Q1 = 48.50-Q3 = 70], 54.5% women) were randomized into a not-painful EE group (NPEE; G0: n = 11) and a painful EE group (PEE; G1: n = 11). The intervention lasted 4 weeks. Pain was recorded using VAS; AROM was measured using a goniometer; and shoulder function using the modified Constant-Murley Score (CMS) before and after intervention. RESULTS: All dependent variables improved significantly in both groups (P < .05): NPEE VAS median: pretest = 55.0 posttest = 28.0; CMS median: pretest = 36.0 posttest = 65.0. PEE VAS median: pretest = 37.0 posttest = 12.0; CMS median: pretest = 35.0 posttest = 59.0. The comparison between groups showed no significant differences, with small effect size values (VAS = 0.09; CMS = 0.21; AROM = 0.12-0.43). DISCUSSION: In contrast to the previous findings, our results suggest that PEE do not add benefit in SS patients compared to NPEE. CONCLUSION: Our results suggest that both interventions are effective in terms of pain, function, and shoulder AROM. Furthermore, PEE does not provide greater benefits. Further studies are needed with long-term follow-up to reinforce these results.

Stretching Exercises for Subacromial Impingement Syndrome: Effects of 6-Week Program on Shoulder Tightness, Pain, and Disability Status.

CONTEXT: Increasing soft tissue flexibility and joint mobility is one of the important aims of studies to treat subacromial impingement syndrome (SIS). OBJECTIVE: The aim of this study was to investigate the effects of a stretching program on posterior capsule tightness, pectoralis minor tightness, pain severity, and disability status in SIS. DESIGN: Single-group pretest posttest design. SETTING: University outpatient clinic. PARTICIPANTS: 18 participants diagnosed with SIS (34.8±9.4 y, symptoms duration 5.8±4.9 months) were included in the study. INTERVENTION: The 6-week self-stretching program for pectoralis minor, posterior capsule, levator scapula, and latissimus dorsi was performed. MAIN OUTCOME MEASURES: Posterior capsule tightness, pectoralis minor tightness, pain severity (visual analog scale), and self-reported shoulder-related pain and disability status (Shoulder Pain and Disability Index) were used to assess changes in flexibility and symptoms. RESULTS: Comparisons showed that there was significantly less posterior capsule and pectoralis minor tightness, less pain severity on activity and at night, and a lower disability score reported after the 6-week stretching program (P < 0.05). There was no statistically significant difference in pain severity at rest after the 6-week stretching program (P > 0.05). CONCLUSIONS: The findings of the study showed that flexibility, pain severity, and disability gains can be achieved with a 6-week stretching exercise training for participants with SIS. Therefore, shoulder girdle stretching exercises should be recommended early in shoulder rehabilitation program.

Effects of Scapular Stabilization Exercise Training on Scapular Kinematics, Disability, and Pain in Subacromial Impingement: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of 2 different exercise programs on 3-dimensional scapular kinematics, disability, and pain in participants with subacromial impingement syndrome (SIS). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic and research laboratory. PARTICIPANTS: Participants who were diagnosed with SIS and who also exhibited scapular dyskinesis (N=30). INTERVENTIONS: The participants were randomized in 2 different exercise groups: (1) shoulder girdle stretching and strengthening with additional scapular stabilization exercises based on a kinetic chain approach (intervention group), and (2) shoulder girdle stretching and strengthening exercises only (control group). MAIN OUTCOME MEASURES: Three-dimensional scapular kinematics, self-reported shoulder pain, and disability were evaluated at baseline, after 6 weeks of training, and after 12 weeks of training. RESULTS: Significant differences were observed between the control and intervention groups in external rotation and posterior tilt after 6 weeks of training and in external rotation, posterior tilt, and upward rotation after 12 weeks of training. All groups showed improvement in self-reported pain and disability scores; however, there were no significant differences between the groups. CONCLUSIONS: Progressive exercise training independent from specific scapular stabilization exercises provides decreased disability and pain severity in impingement syndrome.

Short-Term Effects of Thoracic Spine Manipulation on Shoulder Impingement Syndrome: A Randomized Controlled Trial.

OBJECTIVE: To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. DESIGN: Randomized controlled trial with blinded assessor and patient. SETTING: Laboratory. PARTICIPANTS: Patients with shoulder impingement syndrome (N=61). INTERVENTIONS: Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. MAIN OUTCOME MEASURES: Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. RESULTS: Pain decreased by 0.7 points (95% confidence interval, 1.3-0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5-0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire (P=.01) and Western Ontario Rotator Cuff Index (P=.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (P<.01) at day 2 postintervention (5.3°) and follow-up (3.5°) in the TSM group. Upper trapezius activity increased (P<.05) in the sham-TSM group. Middle trapezius, lower trapezius, and serratus anterior decreased activities in both groups during elevation and lowering of the arm. CONCLUSIONS: TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive.

Specific or general exercise strategy for subacromial impingement syndrome-does it matter? A systematic literature review and meta analysis.

BACKGROUND: Exercise is frequently suggested as a treatment option for patients presenting with symptoms of subacromial impingement syndrome. Some would argue implementing a specific exercise strategy with special focus on correction of kinematic deficits would be superior to general exercise strategy. There is however a lack of evidence comparing such exercise strategies to determine which is the most effective in the treatment of subacromial impingement syndrome. The aim of this review is to evaluate whether implementing specific exercise strategies involving resistive exercises are more effective than a general exercise strategy for the treatment of patients with subacromial impingement syndrome. METHODS: Randomized controlled trials were identified through an electronic search on PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and PEDro. In addition, article reference lists and Clinicaltrials.gov were searched. Studies were considered eligible if they included interventions with resistive specific exercises as compared to general resistance exercise. Four reviewers assessed risk of bias and methodological quality guided by Cochrane recommendations. Results were synthesised qualitatively or quantitatively, where appropriate. RESULTS: Six randomized controlled trials were included with 231 participants who experienced symptoms of subacromial impingement syndrome. Four studies evaluated the effectiveness of specific scapular exercise strategy and two studies evaluated the effectiveness of specific proprioceptive strategy. Five studies were of moderate quality and one study was of low quality. No consistent statistical significant differences in outcomes between treatment groups were reported in the studies. Standardized mean difference (SMD) for pain was SMD -0.19 (95% CI -0.61, 0.22) and SMD 0.30 (95% CI -0.16, 0.76) for function. CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of specific resistive exercise strategies in the rehabilitation of subacromial impingement syndrome. More high quality research is needed to accurately assess this. This review provides suggestions on how to improve the methodological design of future studies in this area.