A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study)

Trials. 2017 Feb 28;18(1):90. doi: 10.1186/s13063-017-1830-x.

Abstract

Background: Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme with standard care in patients with traumatic anterior shoulder dislocations (TASD).

Methods/design: Randomised, assessor-blinded, controlled, multicentre trial. Eighty patients with a TASD will be recruited from three orthopaedic departments in Denmark. Patients with primary or recurrent anterior shoulder dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status (primary or recurrent). Primary outcome will be change from baseline to 12 weeks in the patient-reported QoL outcome questionnaire, the Western Ontario Shoulder Instability Index (WOSI).

Discussion: This trial will be the first study to compare the efficacy and safety of two different nonoperative exercise treatment strategies for patients with TASD. Moreover, this is also the first study to investigate nonoperative treatment effects in patients with recurrent shoulder dislocations. Lastly, this study will add knowledge to the shared decision-making process of treatment strategies for clinical practice.

Trial registration: ClinicalTrials.gov, identifier: NCT02371928 . Registered on 9 February 2015 at the National Institutes of Health Clinical Trials Protocol Registration System.

Keywords: Dislocation; Instability; Neuromuscular exercise; Nonoperative treatment; Physiotherapy; Shoulder.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Biomechanical Phenomena
  • Clinical Decision-Making
  • Clinical Protocols
  • Denmark
  • Disability Evaluation
  • Exercise Therapy / adverse effects
  • Exercise Therapy / methods*
  • Humans
  • Joint Instability / diagnosis
  • Joint Instability / physiopathology
  • Joint Instability / therapy*
  • Quality of Life
  • Range of Motion, Articular
  • Recovery of Function
  • Recurrence
  • Research Design
  • Shoulder Dislocation / diagnosis
  • Shoulder Dislocation / physiopathology
  • Shoulder Dislocation / therapy*
  • Shoulder Joint / physiopathology*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT02371928