Adherence to self-managed exercises for patients with persistent subacromial pain: the Ad-Shoulder feasibility study

Abstract

Background Exercise is recommended for patients with subacromial pain. It has been suggested that good exercise adherence improves clinical outcomes. Despite this, little attention has been paid to the need for behavioural frameworks to enhance adherence to home exercise programmes for patients with subacromial pain. Methods A feasibility study with pre-post design was used. Participants aged > 18 years, with subacromial pain, who had received conservative treatment during the past 6 months, were recruited. The Ad-Shoulder intervention consisted of 1–5 individual sessions provided over 3 months and was based on 5 self-management skills, which aimed to enhance the patients’ self-efficacy and adherence to self-managed exercises. The primary objectives were assessed according to predefined progression criteria: (1) the recruitment rate (10 patients enrolled within 12 weeks), (2) follow-up rate (≥ 80% on all self-reported measures), (3) objective physical activity measures (≥ 80% of participants would contribute valid data at each time point), (4) adherence with the self-managed exercises (≥ 80% of the participants would adhere to ≥ 80% of the assigned home exercise programme), (5) fidelity of the delivery of the intervention (the therapists delivered the intervention according to the protocol) and (6) adverse events (< 30% would report adverse events (including mild)). The results were reported using descriptive statistics. Results Eleven patients were recruited during 16 weeks. Ten patients completed the self-reported measures at baseline and week 12. Objective physical activity measures were successfully obtained for 100% (11/11) at baseline, 64% (7/11) at week six and 82% at week 12. Fifty-five percent (6/11) of the participants satisfactorily completed at least 80% of their home exercise programme. All sessions were delivered according to the protocol. None of the patients reported any adverse events. Conclusions Objective physical activity data measures at baseline and week 12, follow-up, the physiotherapists’ fidelity to the intervention and adverse events met our pre-specified progression criteria. Recruitment and adherence to the self-managed exercise programme were both below the anticipated level. Further intervention development is necessary to understand whether adherence to the self-managed exercises could be enhanced and additional methods of recruitment would need to be considered, including additional recruitment sites, in any planning for a future main trial. Trial registration ClinicalTrials.gov, NCT04190836, Registered December 9, 2019—retrospectively registered

Exercise into pain in chronic rotator cuff related shoulder pain: a prospective single-group feasibility study

“…Considering the individual SPADI changes, only three patients had a significant MIC which was also above the measurement error of 20 points. However, the median change in SPADI score for all patients was 29 points, which was higher than previous estimated values (8–13.2 points)31 and also higher than another recent feasibility study with similar RCRSP population (17 points) by Major et al 32. Although patients were similar in terms of age (around 50 years old) and gender distribution (higher prevalence of women), other differences may have influenced the results, such as previous (failed) treatments in the study by Major et al 32.…”

“…However, the median change in SPADI score for all patients was 29 points, which was higher than previous estimated values (8–13.2 points) 31 and also higher than another recent feasibility study with similar RCRSP population (17 points) by Major et al . 32 Although patients were similar in terms of age (around 50 years old) and gender distribution (higher prevalence of women), other differences may have influenced the results, such as previous (failed) treatments in the study by Major et al . 32 Moreover, our population presented higher SPADI at baseline compared with Major et al , which could have led to greater changes during time.…”

Are progressive shoulder exercises feasible in patients with glenohumeral osteoarthritis or rotator cuff tear arthropathy?

“…This was similar to a study by Sandal et al 2016 investigating the pain trajectory during eight weeks of neuromuscular exercise in patients with hip and knee pain [ 43 ]. Corresponding to a study on self-managed exercises in patients with persistent subacromial pain [ 44 ], no adverse events were registered in our study. Another feasibility study investigating heavy shoulder strengthening exercise in patients with shoulder hypermobility found 33.3% minor adverse events, consisting of short-lasting soreness, ache, “stuck” shoulder, headache and general soreness [ 25 ].…”

Tailored exercise and manual therapy versus standardised exercise for patients with shoulder subacromial pain: a feasibility randomised controlled trial (the Otago MASTER trial)

“…We identified limitations that must be addressed when designing the full trial. Our recruitment rate was lower than previous full trials8 63 but similar to a previous feasibility trial 64. Our ability to enrol participants into the trial during the 9-month period of recruitment was limited by the number of clinicians involved with the study.…”

“…Our recruitment rate was lower than previous full trials 8 63 but similar to a previous feasibility trial. 64 Our ability to enrol participants into the trial during the 9-month period of recruitment was limited by the number of clinicians involved with the study. That impacted on recruitment rate and that can be addressed in the future trial by having a multicentre design.…”