Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial

Héctor Gutiérrez Espinoza; Felipe Araya-Quintanilla; Sebastian Pinto-Concha; Juan Valenzuela-Fuenzalida; José Francisco López-Gil; Robinson Ramírez-Velez

doi:10.1136/bmjsem-2023-001646

Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial

BMJ Open Sport Exerc Med. 2023 Sep 27;9(3):e001646. doi: 10.1136/bmjsem-2023-001646. eCollection 2023.

Authors

Héctor Gutiérrez Espinoza¹, Felipe Araya-Quintanilla², Sebastian Pinto-Concha³, Juan Valenzuela-Fuenzalida^{4

5}, José Francisco López-Gil^{6

7

8}, Robinson Ramírez-Velez^{6

9}

Affiliations

¹ Escuela de Fisioterapia, Universidad de las Americas, Quito, Ecuador.
² Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Salud, Universidad San Sebastián, Santiago, Chile.
³ Physical Therapy Department, Clínica las Condes, Santiago, Chile.
⁴ Department of Morphology and Function, Faculty of Health Sciences, University of Americas, Santiago, Chile.
⁵ Departamento de Ciencias Químicas y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile.
⁶ Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
⁷ Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁸ One Health Research Group, Universidad de las Americas, Quito, Ecuador.
⁹ CIBER of Frailty and Healthy Anging (CIBERFES), Instituto Carlos III, Madrid, Spain.

Abstract

Objectives: Current evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks) effects of a specific exercise programme with a general exercise programme on shoulder function in adults with SIS.

Methods: In total, 52 adults with SIS were randomly allocated to 5 weeks to perform specific exercises (experimental group, n=26) or general exercises (control group, n=26). The primary outcome was change in shoulder function, it was assessed using the Shoulder Pain and Disability Index (SPADI) from baseline to 5 weeks. Secondary end points included changes in upper limb function (Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire), pain intensity (Visual Analog Scale (VAS)) and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)).

Results: All participants completed the trial. The between-group differences at 5 weeks were: SPADI, 13.5 points (95% CI: 4.3 to 15.6; ƞ²=0.22; p=0.001); DASH, 10.1 points (95% CI: 5.6 to 15.2; ƞ²=0.27; p<0.001); VAS at rest, 0.2 cm (95% CI: 0.1 to 0.3; ƞ²=0.07; p=0.553); VAS on movement, 1.7 cm (95% CI: 0.9 to 2.2; ƞ²=0.24; p<0.001); and TSK, 16.3 points (95% CI: 13.2 to 15.3; ƞ²=0.33; p<0.001). All differences favoured the experimental group and effect sizes were medium to large for most outcomes. Mediation analyses showed that the effect of the specific exercises on shoulder function was mediated by kinesiophobia (β=2.800; 95% CI: 1.063 to 4.907) and pain on movement (β= -0.690; 95% CI: -1.176 to -0.271).

Conclusion: In adults with SIS, specific exercises may have a larger effect than general exercises. However, most differences did not reach the minimum threshold to be considered clinically important and the evidence to support exercise as standard treatment warrant further study.

Trial registration number: Brazilian Registry of Clinical Trials UTN number U111-1245-7878. Registered on 17 January 2020 (https://ensaiosclinicos.gov.br/rg/RBR-4d5zcg).

Keywords: exercise rehabilitation; randomised controlled trial; shoulder.