Does the addition of motor control or strengthening exercises to education result in better outcomes for rotator cuff-related shoulder pain? A multiarm randomised controlled trial

Abstract

ObjectiveTo compare the short-term, mid-term and long-term effects between three interventions (education only, education and strengthening exercises, education and motor control exercises) for rotator cuff-related shoulder pain (RCRSP) on symptoms and function.Methods123 adults presenting with RCRSP took part in a 12-week intervention. They were randomly assigned to 1 of 3 intervention groups. Symptoms and function were evaluated at baseline and at 3 weeks, 6 weeks, 12 weeks and 24 weeks using the Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) (primary outcome) and Western Ontario Rotator Cuff Index (WORC). Linear mixed modelling was used to compare the effects of the three programmes on the outcomes.ResultsAfter 24 weeks, between-group differences were −2.1 (-7.7 to 3.5) (motor control vs education), 1.2 (-4.9 to 7.4) (strengthening vs education) and −3.3 (-9.5 to 2.8) (motor control vs strengthening) for theQuickDASH and 9.3 (1.5 to 17.1) (motor control vs education), 1.3 (−7.6 to 10.2) (strengthening vs education) and 8.0 (−0.5 to 16.5) (motor control vs strengthening) for the WORC. There was a significant group-by-time interaction (p=0.04) withQuickDASH, but follow-up analyses did not reveal any clinically meaningful between-group differences. There was no significant group-by-time interaction (p=0.39) for the WORC. Between-group differences never exceeded the minimal clinically important difference ofQuickDASH or WORC.ConclusionIn people with RCRSP, the addition of motor control or strengthening exercises to education did not lead to larger improvements in symptoms and function compared with education alone. Further research should investigate the value of providing stepped care by identifying individuals who may only need education and those who would benefit from the addition of motor control or strengthening exercises.Trial registration numberNCT03892603.

Shoulder & Elbow

“…Researchers from Quebec (Canada) have therefore performed an extremely relevant multi-arm randomized controlled trial to determine the effect of the addition of formal strengthening exercises or motor control exercises to education-alone interventions for rotator cuff-related shoulder pain. 7 The authors were able to recruit 123 adult patients meeting the diagnostic criteria to their study. Participants were enrolled and then underwent a 12-week intervention programme.…”

Shoulder & Elbow

“…Surgeons in Quebec (Canada) compared three treatment interventions (education only, education and strengthening exercises, and education and motor control exercises) in a multi-arm randomized controlled trial. 1 A total of 123 patients between the ages of 18 and 75 years were randomized to the interventions and treated for 12 weeks, with follow-up until 24 weeks. The abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and Western Ontario Rotator Cuff Index (WORC) scores were used to measure outcomes.…”

Rotator cuff disorders: An updated survey of current (2023) UK physiotherapy practice

“…Previous surveys of physiotherapist practice in 2012 (Littlewood et al., 2012) and 2016 (Bury & Littlewood, 2018) have described practice at those time points with the most recent UK survey, in 2016, reporting that physiotherapists commonly delivered treatment for shoulder rotator cuff disorders across three to six sessions, and that treatment predominantly consisted of advice/education and exercise‐based interventions. However, since the publication of the 2016 survey, further research has been published suggesting uncertainty in the effectiveness of treatment by a physiotherapist for people with shoulder pain due to rotator cuff disorder (Dubé et al., 2023; Hopewell et al., 2021; Liaghat et al., 2021; Naunton et al., 2020). A large UK‐based randomised controlled trial (RCT) recruited 708 patients from the NHS (Hopewell et al., 2021) and compared: one session with a physiotherapist but no steroid injection one session with a physiotherapist with a steroid injection up to six sessions with a physiotherapist but no steroid injection up to six sessions with a physiotherapist with a steroid injection …”