- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04027205
Surgery Versus PhysiothErapist-leD Exercise for Traumatic Tears of the Rotator Cuff (SPeEDy)
Surgery Versus PhysiothErapist-leD Exercise for Traumatic Tears of the Rotator Cuff: a Multi-site Pilot and Feasibility Randomised Controlled Trial (the SPeEDy Study)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Tears of the rotator cuff are a significant cause of shoulder pain. Rates of surgical repair have risen approximately 200% over the last 20 years across Europe and the USA. 9 189 repairs were undertaken in 2015/ 2016 in the NHS. The cost of surgery ranges from £2 897 to £5 593 meaning that direct NHS treatment costs alone are £26.6 to £51.4 million annually.
If a patient is suspected of having a traumatic rotator cuff tear, then guidance from the British Elbow and Shoulder Society and British Orthopaedic Association suggests this is a 'red flag' needing urgent surgical opinion. But, this guidance is open to question. Three randomised controlled trials (RCT) (n = 252) have been synthesised in a systematic review which concluded that surgery is not more effective than conservative care for rotator cuff tears. But, of the 252 patients included, only 40 (16%), were diagnosed with traumatic tears. Hence, there is a dearth of randomised evidence to inform decision-making.
Given uncertainty about the comparative effectiveness of surgery and considering the cost, risk, for example infection, there is an urgent need to carry out high-quality research in this area.
Research Question: In patients diagnosed with traumatic tears of the rotator cuff, is it feasible to conduct a future multicentre RCT to test the hypothesis that physiotherapist-led exercise is not inferior to surgical repair in terms of clinical outcomes but is more cost-effective.
Research Design: Two-arm, parallel group, pilot and feasibility RCT with nested Quintet Recruitment Intervention (QRI) and qualitative interviews.
Setting: Eight NHS hospitals.
Objectives:
- Determine feasibility of recruiting and retaining patients,
- Identify barriers and facilitators to recruitment and retention, including patient and clinician equipoise and proportion and reasons for treatment cross-over (reflective of known challenges in surgical RCTs),
- Estimate the number of potential and willing sites for the future main trial.
Participants: Adults with traumatic tears of the rotator cuff, eligible for surgery.
Intervention/ control: Participants will be allocated on a 1:1 ratio, stratified by tear size to: 1) Structured and progressive physiotherapist-led exercise; 2) Surgical repair and usual post-operative rehabilitation.
Key feasibility outcomes: 1) Numbers of patients screened, eligible, approached, consenting, randomised, and accepting allocation; 2) Rate of retention and follow-up; 3) Feasibility of recruiting participating sites; 4) Participant satisfaction.
Key clinical outcomes: 1) Shoulder pain and function (Oxford Shoulder Score): Quality of life (EQ-5D-5L) at baseline, three, and six months.
Health economic outcomes: Health care resource use and days lost from work over six-months.
Sample size: 76 participants.
Analysis: Analysis will focus on process outcomes (recruitment, retention, and treatment cross-over). Means and confidence intervals of clinical outcomes will be calculated only to inform the sample size calculation for the future main trial.
The QRI will use targeted methods including interviews with clinicians and patients, audio-recording of recruitment appointments and document review to understand and then develop an action plan to optimise recruitment and informed consent. Semi-structured qualitative interviews will explore treatment acceptability and the data will be analysed thematically.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Derby, United Kingdom
- University Hospital of Derby & Burton NHS
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult patients (≥18 years)
- Diagnosed with a symptomatic tear of the rotator cuff following a traumatic incident thought to be of sufficient force to induce a tear.
- Rotator cuff tear confirmed by diagnostic ultrasound or MRI scan undertaken as part of routine diagnostic work-up
- Eligible for rotator cuff repair surgery or a programme of physiotherapist-led exercise as determined by the attending clinician (surgeon or physiotherapist, where appropriate)
- Able to return to the participating NHS hospital or associated orthopaedic and physiotherapy services (where physiotherapists have been trained in trial interventions) for post-operative rehabilitation or the programme of physiotherapist-led exercise.
- Able to understand English.
Exclusion Criteria:
- Not eligible for rotator cuff repair surgery or a programme of physiotherapist-led exercise as determined by the attending clinician (surgeon or physiotherapist, where appropriate)
- Patients who are unable to give full informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Physiotherapist-led exercise
Structured and progressive physiotherapist-led exercise programme.
Reflective of current guidance for exercise programmes for people with rotator cuff disorders, an individualised programme developed in relation to the participant's specific goals will be prescribed by the physiotherapist and supported over approximately six contact sessions across a 12-week period.
|
A programme of physiotherapist-led exercise over approximately 12 weeks.
|
Active Comparator: Surgical repair
Surgical repair of the rotator cuff plus usual post-operative rehabilitation.
|
Surgical repair of the rotator cuff plus usual post-operative rehabilitation
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Numbers of patients screened, number eligible, number approached, number consenting, number randomised, and number accepting allocation
Time Frame: Over recruitment period, 15 months
|
Numbers of patients screened, number eligible, number approached, number consenting, number randomised, and number accepting allocation will be recorded descriptively
|
Over recruitment period, 15 months
|
Numbers of participants continuing in allocated treatment
Time Frame: Six months
|
Numbers of participants continuing in allocated treatment will be recorded descriptively
|
Six months
|
Follow-up response rates to questionnaires (including Oxford Shoulder Score and EQ-5D-5L)
Time Frame: Three months post-randomisation
|
Follow-up response rates to questionnaires will be recorded descriptively
|
Three months post-randomisation
|
Follow-up response rates to questionnaires (including Oxford Shoulder Score and EQ-5D-5L)
Time Frame: Six months post-randomisation
|
Follow-up response rates to questionnaires will be recorded descriptively
|
Six months post-randomisation
|
Determination of zone of clinical equipoise
Time Frame: Over recruitment period, 15 months
|
Data from screening logs, including reasons for not approaching potentially eligible patients will be recorded descriptively to inform determination of zone of clinical equipoise
|
Over recruitment period, 15 months
|
Treatment cross-over
Time Frame: Six months
|
Numbers of participants receiving treatment (surgery or PT-led exercise) other than that which was allocated to determine proportion of participants who cross-over will be recorded descriptively
|
Six months
|
Participant satisfaction with the interventions: five-point ordinal scale
Time Frame: Six months
|
Participant satisfaction with the interventions on a five-point ordinal scale; Very Satisfied/Satisfied/Neutral/Dissatisfied/Very Dissatisfied
|
Six months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain and disability assessed using the Oxford Shoulder Score (OSS)
Time Frame: Three and six months post-randomisation
|
The OSS is a 12-item shoulder-specific self-report measure of shoulder pain and function primarily for the assessment of outcome of shoulder surgery in RCTs.
The OSS is reliable, valid, responsive and acceptable to patients.
The items refer to the past 4 weeks with five ordinal response options scored from 0 to 4, with 4 representing the best outcome.
When the 12 items are summed, this produces an overall score ranging from 0 to 48, with 48 being the best outcome.
|
Three and six months post-randomisation
|
Health related quality of life assessed using the EQ-5D-5L
Time Frame: Three and six months post-randomisation
|
The EQ-5D-5L is a generic measure of health related quality of life that provides a single index value for health status that can be used for the purpose of clinical and health economic evaluation.
The EQ-5D-5L consists of questions relating to five health domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and respondents rate their degree of impairment using five response levels (no problems, slight problems, moderate problems, severe problems and extreme problems).
The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions.
This decision results in a 1-digit number that expresses the level selected for that dimension.
The digits for the five dimensions can be combined into a 5-digit number that describes the patient's health state.
A total of 3125 possible health states can be defined in this way which can then be converted in to a single index value between 0 and 1,
|
Three and six months post-randomisation
|
Days lost from work due to the shoulder problem
Time Frame: Three and six months post-randomisation
|
Days lost from work due to the shoulder problem will be recorded descriptively on a self-report questionnaire
|
Three and six months post-randomisation
|
Time taken to return to driving
Time Frame: Three and six months post-randomisation
|
Time taken to return to driving will be recorded descriptively on a self-report questionnaire
|
Three and six months post-randomisation
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of recruiting participating sites and numbers of additional sites who are interested in participating in the main trial
Time Frame: Whole study period, 36 months
|
Number of recruiting participating sites and numbers of additional sites who are interested in participating in the main trial will be recorded descriptively
|
Whole study period, 36 months
|
Number and type of adverse events
Time Frame: Up to six months post-randomisation
|
Number and type of adverse events will be recorded descriptively following patient or clinician report
|
Up to six months post-randomisation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Chris Littlewood, PhD, Manchester Metropolitan University
Publications and helpful links
General Publications
- Littlewood C, Wade J, Butler-Walley S, Lewis M, Beard D, Rangan A, Bhabra G, Kalogrianitis S, Kelly C, Mehta S, Singh HP, Smith M, Tambe A, Tyler J, Foster NE. Protocol for a multi-site pilot and feasibility randomised controlled trial: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff (the SPeEDy study). Pilot Feasibility Stud. 2021 Jan 7;7(1):17. doi: 10.1186/s40814-020-00714-x.
- Littlewood C, Astbury C, Bush H, Gibson J, Lalande S, Miller C, Pitt L, Tunnicliffe H, Winstanley R. Development of a physiotherapist-led exercise programme for traumatic tears of the rotator cuff for the SPeEDy study. Physiotherapy. 2021 Jun;111:66-73. doi: 10.1016/j.physio.2020.07.008. Epub 2020 Aug 3.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- RG-0292-19-IPCHS
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Supporting Information Type
- Study Protocol
- Clinical Study Report (CSR)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Traumatic Rotator Cuff Tear
-
Western Orthopaedics Research and Education FoundationAlloSourceRecruitingRotator Cuff Tear or Rupture, Not Specified as TraumaticUnited States
-
Andrews Research & Education FoundationFloridaRecruitingRotator Cuff Tear or Rupture, Not Specified as TraumaticUnited States
-
University Hospital, Basel, SwitzerlandCompletedRotator Cuff Tear or Rupture, Not Specified as TraumaticSwitzerland
-
Manchester University NHS Foundation TrustRecruitingRotator Cuff Tear | Rotator Cuff Tear or Rupture, Not Specified as TraumaticUnited Kingdom
-
Schulthess KlinikRecruitingRotator Cuff Tear or Rupture, Not Specified as TraumaticSwitzerland
-
Kantonsspital Winterthur KSWUniversiteit AntwerpenCompletedRotator Cuff Tear or Rupture, Not Specified as TraumaticSwitzerland
-
Tartu University HospitalUniversity of TartuNot yet recruitingRotator Cuff Injuries | Rotator Cuff Tear or Rupture, Not Specified as Traumatic | Rotator Cuff TearsEstonia
-
Bezmialem Vakif UniversityNot yet recruitingRotator Cuff Tears | Partial Tear of Rotator CuffTurkey
-
Clinical Exercise Physiology and Rehabilitation...Not yet recruitingRotator Cuff Tear or Rupture, Not Specified as Traumatic | Rotator Cuff Tears | Rotator Cuff Tendinosis | Rotator Cuff Syndrome | Rotator Cuff Impingement
-
Rush University Medical CenterSmith & Nephew, Inc.CompletedRotator Cuff Tear Repair Anchors
Clinical Trials on Physiotherapist-led exercise
-
University Hospitals of Derby and Burton NHS Foundation...Recruiting
-
Hvidovre University HospitalDuke University; La Trobe UniversityUnknownFemoroacetabular ImpingementDenmark
-
Vastra Gotaland RegionNot yet recruiting
-
Horsens HospitalUniversity of Aarhus; La Trobe UniversityNot yet recruitingFemoroacetabular Impingement
-
Hasan Kalyoncu UniversityCompleted
-
Jordan Miller, PT, PhDCanadian Institutes of Health Research (CIHR)RecruitingBack Pain, LowCanada
-
Queen's UniversityCanadian Institutes of Health Research (CIHR)Completed
-
University of SaskatchewanMultiple Sclerosis Society of CanadaCompleted
-
Istanbul Medeniyet UniversityNot yet recruiting
-
Istanbul Medeniyet UniversityNot yet recruiting