Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement

December 12, 2023 updated by: University Ghent

Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Shoulder Impingement Syndrome

A randomized controlled trial will be conducted to examine the effectiveness of a traditional home exercise program versus 2 kinetic chain home exercise programs on treatment outcome of overhead athletes with shoulder impingement syndrome. Primary outcome measures are reduction of pain and disability, and improvement in functionality and sports performance. Secondary outcome measures are strength, mobility, flexibility and functional performance.

Study Overview

Detailed Description

Participant are randomly assigned in 3 home exercise groups.

  1. The traditional program: consists of solely strengthening the rotator cuff muscles and scapular muscles (e.g. external rotation)
  2. Separate kinetic chain program: same exercises as the first group but they also receive an exercise program to separately train the core and lower body. (e.g. external rotation separately and squat separately)
  3. Integrated kinetic chain program: same exercises as the first group but all exercises are performed while simultaneously activating the kinetic chain. (e.g. external rotation while squatting).

Study Type

Interventional

Enrollment (Actual)

38

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Ghent, Belgium, 9000
        • Vakgroep REVAKI (Ghent University - Ghent University Hospital)

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Symptoms of shoulder impingement on the dominant side for at least 3 months and at least 3 of the following tests are considered positive

    • Jobe
    • Hawkins
    • Neer
    • Painful arc during elevation
    • Pain or lack of force production with isometric external rotation
    • Apprehension test
    • Relocation test
  • Performing overhead sports at least 3 hours/week
  • Shoulder pain interferes with sports activities
  • They have not had treatment for this shoulder pain

Exclusion Criteria:

  • History of shoulder dislocation or subluxation
  • History of orthopedic surgery
  • No complaints of pain or dysfunction in the upper limb (except impingement related complaints in the dominant shoulder), lower limb or spine at the last 6 months
  • Currently taking nonsteroidal anti-inflammatory medication
  • Received a steroid injection in the past 12 months
  • Participating in another study
  • Known systemic diseases
  • Known structural diseases

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Traditional training
A home exercise program consisting of rotator cuff and scapular muscle training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.
Experimental: Separate kinetic chain training
A home exercise program consisting of traditional training exercises as well as separate exercises focusing on core and lower limb training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.
Experimental: Integrated kinetic chain training
A home exercise program consisting of traditional training exercises while integrating core and lower limb training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in Shoulder Pain And Disability Index (SPADI) score
Time Frame: At baseline and within one week after the 6-weeks training program
Patients will fill in the SPADI questionnaire to evaluate shoulder pain and function. The SPADI is a valid, reliable and frequently used questionnaire for shoulder pain patients consisting of 13 items divided in 2 subscales: pain (5 items) and disability (8 items). Each item was scored on a 10-point numeric rating scale. Total and subscale scores were summed and transformed to a score out of 100 (%) were a higher score indicates a higher level of pain and/or disability
At baseline and within one week after the 6-weeks training program
Changes in Western Ontario Shoulder Stability index (WOSI) score
Time Frame: At baseline and within one week after the 6-weeks training program
The WOSI is a patient-evaluated disease-specific quality of life scoring questionnaire that has been developed for shoulder instability patients. This 21-item questionnaire consists of 4 subscales: physical symptoms (10 items), sport/recreation/work (4 items), lifestyle (4 items), and emotions (3 items). Each item was scored on a 100-mm visual analogue scale. Total and subscale scores were summed and transformed to a score out of 100 (%) where a higher score indicates more limitations in shoulder related quality of life
At baseline and within one week after the 6-weeks training program
Subjective perception of shoulder improvement
Time Frame: 6-weeks training program

A Global Rating of Change (GROC) scale was used to quantify patient-perceived improvement of overall shoulder function after 6 weeks treatment as "improved", "unchanged" or "worse". In case they improved or got worse, the amount of change was reflected on a 5-point scale: very little change, little change, some change, a large change, a very large change. An "unchanged" condition scored 0, "improved" between 1 and 5, and "worse" between -1 and -5 points.

amount of change was scored on a 5-point scale (very little change, little change, some change, a large change, a very large change)

6-weeks training program

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Changes in shoulder muscle isokinetic strength (Biodex system 4)
Time Frame: at baseline and within one week after the 6-weeks training program
Isokinetic strength of shoulder internal and external rotators will be measured bilateral with the Biodex device (Biodex system 4, Biodex Medical Systems, Inc., Shirley, New York, USA). For further analysis, concentric peak torque (PT) (rotation) or peak force (PF) (protraction-retraction) values were normalized to body weight (BW). A higher value represents more strength and thus a better outcome.
at baseline and within one week after the 6-weeks training program
Changes in shoulder scapular isokinetic strength
Time Frame: at baseline and within one week after the 6-weeks training program
Isokinetic strength of scapular protraction and retraction muscles will be measured bilateral with the Biodex device (Biodex system 4, Biodex Medical Systems, Inc., Shirley, New York, USA). For further analysis, concentric peak torque (PT) (rotation) or peak force (PF) (protraction-retraction) values were normalized to body weight (BW). A higher value represents more strength and thus a better outcome.
at baseline and within one week after the 6-weeks training program
Changes in scapular dyskinesis
Time Frame: at baseline and within one week after the 6-weeks training program
Scapular dyskinesis will be measured by observing the scapular movement during active elevation. For both sides (left and right), scapular dyskinesis was evaluated as being present or not. In case dyskinesis was present, the amount of dyskinesis is scored as subtle or prominent.
at baseline and within one week after the 6-weeks training program
Changes in functional tests for the upper limb measured with the Y Balance Test
Time Frame: at baseline and within one week after the 6-weeks training program
The YBT-UQ is a commonly used upper extremity functional test to assess closed kinetic chain function of the stance arm while performing an open kinetic chain movement in the reaching arm. Under standardized verbal encouragement, patients stand in a three point plank position while using the free arm to push a reach indicator box as far as possible in 3 reach directions i.e. medial, inferolateral and superolateral.The average of the 3 test trials for each limb and each direction was normalized for upper limb length. Additionally, a normalized composite score per side was calculated by averaging the mean normalized test scores in the 3 reach directions. A higher scores indicates a better outcome.
at baseline and within one week after the 6-weeks training program
Return To Play (RTP)
Time Frame: up to one week after the 6-weeks training program
Is it possible to return to play after 6 weeks intervention or not? In addition, following question was asked: on a scale of 0 to 100%, what is the extent to which the injured shoulder has reached the shoulder function before the injury occurred?
up to one week after the 6-weeks training program
Changes in functional tests for the upper limb measured with the Seated Medicine Ball Throw
Time Frame: at baseline and within one week after the 6-weeks training program
The SMBT is an open kinetic chain functional screening test to assess bilateral upper body power and strength. The subjects were instructed to sit on the floor with the head, shoulder and back against the wall while holding a 2kg medicine ball with both arms.Participants had to throw the medicine ball forward, in a straight line and as far as possible with head, shoulders and back maintaining full wall contact. For further analysis, the mean distance of 4 test trials was calculated. A higher scores indicates a better outcome.
at baseline and within one week after the 6-weeks training program

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Ann Cools, PT, PhD, University Ghent

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

September 1, 2015

Primary Completion (Actual)

June 1, 2018

Study Completion (Actual)

June 1, 2018

Study Registration Dates

First Submitted

September 29, 2015

First Submitted That Met QC Criteria

January 29, 2016

First Posted (Estimated)

February 1, 2016

Study Record Updates

Last Update Posted (Actual)

December 18, 2023

Last Update Submitted That Met QC Criteria

December 12, 2023

Last Verified

December 1, 2023

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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