Effect of exercise-based management on multidirectional instability of the glenohumeral joint: a pilot randomised controlled trial protocol

Abstract

IntroductionThe most commonly recommended treatment for multidirectional instability (MDI) of the shoulder is exercise. Despite this recommendation, there is limited evidence to support the effectiveness of exercise. The aim of this paper is to describe a pilot randomised controlled trial comparing the effectiveness of 2 exercise programmes on outcomes of participants with MDI.Methods and analysisConsenting participants between 12 and 35 years, with non-traumatic MDI will be randomly allocated to participate in either the Rockwood Instability programme or the Watson MDI programme. Both programmes involve 1 consultation per week for 12 weeks with a physiotherapist to prescribe and progress a home exercise programme. Outcomes will be assessed at baseline, 6, 12, 24 and 52 weeks. Primary outcome measures include the Melbourne Instability Shoulder Score and Western Ontario Shoulder Index. Secondary outcomes include scapular coordinates, scapular upward rotation angles, muscle strength, symptomatic onset, limiting factor and angle of limiting factor in abduction range, incidence of complete glenohumeral joint dislocation, global rating of change, satisfaction scores, the Orebro Musculoskeletal Pain Questionnaire, adverse events and compliance with the home exercise programme. Data will be analysed on intention-to-treat principles and a per protocol basis.DiscussionThis trial will evaluate whether there are differences in outcomes between the Rockwood and the Watson MDI programmes for participants with MDI.Ethics and disseminationParticipant confidentiality will be maintained with publication of results. Ethics approval: Faculty of Health Sciences (FHEC12/201).Trial registration numberACTRN12613001240730; Pre-results.

Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial

“…This multicenter RCT was prospectively registered (ACTRN12613001240730; Australian New Zealand Clinical Trials Registry) and the protocol published. 52 The flow of participants through the trial is outlined in Figure 1. The La Trobe University Human Ethics Committee (FHEC12/201) approved this trial.…”

“…Participants read a detailed information sheet and signed a written consent form. 52 Participants were randomly allocated to one of two 12-week exercise programs: the Rockwood Instability program or the Watson MDI program.…”

“…Eligible participants were aged 12 to 35 years and had symptomatic glenohumeral joint subluxation or dislocation in >1 direction. 2,4,52 Diagnosis was based on a positive sulcus sign and a positive test (drawer test and/or apprehension test) for anterior and/or posterior instability. 52 Apprehension was the criterion for a positive instability test, not just pain or signs of laxity.…”

“…2,4,52 Diagnosis was based on a positive sulcus sign and a positive test (drawer test and/or apprehension test) for anterior and/or posterior instability. 52 Apprehension was the criterion for a positive instability test, not just pain or signs of laxity. 52 These tests are valid and reliable for diagnosing instability when apprehension is used as the criterion for a positive test.…”

“…52 Apprehension was the criterion for a positive instability test, not just pain or signs of laxity. 52 These tests are valid and reliable for diagnosing instability when apprehension is used as the criterion for a positive test. 52…”