Development and delivery of a physiotherapist-led exercise intervention in a randomised controlled trial for subacromial impingement syndrome (the SUPPORT trial)

Kay Stevenson; Sue Jackson; Julie Shufflebotham; Edward Roddy; Nadine E Foster

doi:10.1016/j.physio.2017.03.005

Development and delivery of a physiotherapist-led exercise intervention in a randomised controlled trial for subacromial impingement syndrome (the SUPPORT trial)

Physiotherapy. 2017 Dec;103(4):379-386. doi: 10.1016/j.physio.2017.03.005. Epub 2017 Mar 24.

Authors

Kay Stevenson¹, Sue Jackson², Julie Shufflebotham³, Edward Roddy⁴, Nadine E Foster⁵

Affiliations

¹ Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke on Trent, Staffordshire, ST6 7AG, UK; Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK; University Hospital of North Midlands, London Road, Newcastle under Lyme, Staffordshire, ST4 6QG, UK. Electronic address: kay.stevenson@uhns.nhs.uk.
² University Hospital of North Midlands, London Road, Newcastle under Lyme, Staffordshire, ST4 6QG, UK. Electronic address: sue.jackson@uhns.nhs.uk.
³ Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK; Cheadle Hospital, Royal Walk, Cheadle, Staffordshire, UK. Electronic address: julieC.shufflebotham@ssotp.nhs.uk.
⁴ Staffordshire Rheumatology Centre, Haywood Hospital, High Lane, Burslem, Stoke on Trent, Staffordshire, ST6 7AG, UK; Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. Electronic address: e.roddy@keele.ac.uk.
⁵ Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. Electronic address: n.foster@keele.ac.uk.

PMID: 28818450
DOI: 10.1016/j.physio.2017.03.005

Abstract

Purpose: This paper describes the development, content and delivery of a physiotherapist- led individualised, supervised and progressed exercise programme for use in a factorial randomised controlled trial testing treatments for subacromial impingement syndrome.

Methods: To develop the intervention, a survey of community physiotherapists and national guidelines provided the basis for a consensus workshop through which a protocol was developed for the SUPPORT trial physiotherapist-led exercise programme (SUPPORT: SUbacromial impingement syndrome and Pain: a randomised controlled trial Of exeRcise and injection). The protocol included three stages of exercise progression: (1) scapular stability and active exercise with no resistance (2) range of motion exercise with scapular control, isometrics and stretches, and (3) through range resistance exercise. A two day training programme was developed for physiotherapists which included the trial background, current evidence and strategies to improve exercise adherence.

Results: Twenty physiotherapists were trained to deliver the exercise intervention. In the SUPPORT trial, 128 participants were randomised to physiotherapist-led exercise. Ninety nine (81%) participants had their first physiotherapy session within 2 to 3 weeks and 71 (56%) received six to eight treatment sessions. Frequently-used exercises were: stage 1 scapular setting with glenohumeral joint (GHJ) flexion to 90°, stage 2 GHJ medial rotation stretch, stage 3 scapular setting through lateral rotation, with resistance bands.

Conclusion: We combined clinical and research expertise with national guidance in order to develop a physiotherapist-led, individualised, progressed and supervised exercise intervention for use within a randomised trial. The effectiveness of the intervention is being evaluated within the SUPPORT trial. Trial registration number ISRCTN 42399123.

Keywords: Exercise; Physiotherapy; Rehabilitation; Shoulder; Subacromial impingement syndrome (SIS).

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Exercise Therapy / methods*
Female
Humans
Male
Physical Therapy Modalities
Range of Motion, Articular
Resistance Training / methods
Scapula / physiopathology
Shoulder Impingement Syndrome / rehabilitation*

Abstract

Publication types

MeSH terms

Grants and funding