- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04154345
Exercise Into Pain in Chronic Rotator Cuff Related Shoulder Pain: a Prospective Single-Group Feasibility Study
July 27, 2023 updated by: Filip Struyf, Universiteit Antwerpen
The purpose of this study is to evaluate a) the feasibility of applying a painful exercise program in the treatment of subacromial shoulder pain and b) the time needed to collect clinical outcomes for a future randomized controlled trial.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Exercise therapy is the first choice of treatment in the management of subacromial shoulder pain (SSP).
Guidelines suggest active rehabilitation program for at least three months and existing research highlights the importance of progressive loaded exercise therapy at higher dosage.
However, it is not clear which is the best type of exercise and if pain should be provoked during exercise.
Recent research found that painful exercises are beneficial in short term on pain and function in patients with different kinds of chronic musculoskeletal pain.
The aim of the future randomized clinical trial is to investigate if "exercising into pain" gives better results in term of clinical outcomes compared to a non-painful exercise program.
Since the intervention consists in painful exercises, it is essential to test the rate of adherence in the intervention group (both during physiotherapist-led session and home-based exercises).
Moreover, the practicability of clinical questionnaire via online survey will be tested and the time needed to collect clinical data will be calculated as well.
Furthermore, feedback from physiotherapists and participants will be collected and analyzed.
Study Type
Interventional
Enrollment (Actual)
12
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
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Antwerp, Belgium
- Physiotherapy private practices
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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 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Age 18-65 years
- Shoulder pain for at least 3 months
- Pain in the antero-lateral shoulder region
- At least 3 out of 5 of the following tests positive: Neer test, Hawkins-Kennedy, Jobe, painful arc between 60° and 120°, external resistance test
- Resting pain should be at 2/10 maximum on verbal NRS scale
- All types of occupations were included: students, workers (including overhead workers or heavy duty workers), people on sick leave and retired people
Exclusion Criteria:
- Bilateral shoulder pain
- Corticosteroid injections 6 weeks prior to the study
- Pregnancy, inability to understand spoken or written Dutch
- Clinical signs of full-thickness rotator cuff tears (positive external and internal rotation lag tests and drop arm test)
- Evidence of adhesive capsulitis (50% or more than 30° loss of passive external rotation)
- Previous cervical, thoracic or shoulder surgery; recent fractures or dislocations on the painful shoulder
- Symptoms of cervical radiculopathy as primary complaint (tingling, radiating pain in the arm associated with neck complaints)
- Primary diagnosis of acromioclavicular pathology, shoulder instability
- A radiologically confirmed fracture or presence of calcification larger than 5 mm
- Presence of competing pathologies (inflammatory arthritis, neurological disorders, fibromyalgia, malignancy)
- More than 4h of training in sport overhead shoulder activities per week
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: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Painful exercises
The pain allowed during exercises ranges between 4 and 7 on NPRS (Numeric Pain Rating Scale)
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The intervention consists of 12 weeks of progressive loaded exercises, three times per week.
There are 9 sessions of supervised physiotherapy treatment, lasting 30 minutes, while the rest of the sessions is conducted as home exercises.
There are 4 strengthening exercises, in which the pain allowed ranges between 4 and 7 on a verbal NPRS for 9 weeks, then pain ratings are 0-2 for the remaining 3 weeks.
Every physiotherapy session includes also 15 minutes of manual therapy.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Shoulder Pain and Disability Index (SPADI)
Time Frame: change from baseline to 12 weeks
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There are 13 items, divided in two subscales: pain (5 items) and function (8 items).
Each item is scored from 0 (no pain/no difficulty) to 10 (worst imaginable pain/so difficult it requires help) on a NPRS.
The final score is a percentage derived from an average of the two subscales, where higher score means worse outcome.
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change from baseline to 12 weeks
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Rate of adherence
Time Frame: measurement every week, change from baseline to 12 weeks
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It is analysed in terms of attendance to the physiotherapist-led sessions and adherence to the home-exercise protocol.
Good level of adherence is defined by: attendance of 7/9 (78%) of physiotherapist led-sessions and 22/27 (81%) days of home-exercises completed.
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measurement every week, change from baseline to 12 weeks
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Maximum Voluntary Contraction (MVC) in internal rotation, external rotation, scaption
Time Frame: baseline, 6 weeks, 12 weeks
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It is measured with the Hand-Held Dynamometer.
The unit of measure is Newtons.
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baseline, 6 weeks, 12 weeks
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Range of Movement (ROM) in internal rotation, external rotation, scaption
Time Frame: baseline, 6 weeks, 12 weeks
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It is measured with the inclinometer.
The unit of measure is degrees.
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baseline, 6 weeks, 12 weeks
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Scapular dyskinesis
Time Frame: baseline, 6 weeks, 12 weeks
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It is measured with visual observation during the following clinical tests: 1) scapular dyskinesis at rest and during movement (loaded and unloaded, in abduction and in flexion); the presence of winging, tilting or abnormal scapular movement determines the judgement about scapular dyskinesis (yes/no) at rest and during movement; 2) the scapular assistance test (SAT); if the pain reduces after the SAT, the test is considered positive; 3) scapular retraction test (SRT); if the pain reduces after the SRT, the test is considered positive.
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baseline, 6 weeks, 12 weeks
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Fear-Avoidance Beliefs Questionnaire (FABQ)
Time Frame: baseline,6 weeks, 12 weeks
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It consists of 16 items and it has 2 subscales: Physical Activity (FABQ-PA, range: 0-24) and Work (FABQ-W, range: 0-42) higher scores mean more fear avoidance beliefs affecting physical activity and/or work.
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baseline,6 weeks, 12 weeks
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Fear of Pain Questionnaire (FPQ-9)
Time Frame: baseline, 6 weeks, 12 weeks
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It is a shortened version of the Fear of Pain Questionnaire-III.
The total score ranges between 9 and 45; higher scores mean more fear and anxiety associated with pain.
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baseline, 6 weeks, 12 weeks
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acromiohumeral Distance (AHD)
Time Frame: baseline, 6 weeks, 12 weeks
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It is measured with the Ultrasound machine at rest and at 60 degress of elevation in the scapular plane.
(in millimiters)
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baseline, 6 weeks, 12 weeks
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Supraspinatus tendon thickness (STT)
Time Frame: baseline, 6 weeks, 12 weeks
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It is measured with the Ultrasound machine in the Crass position (in millimeters)
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baseline, 6 weeks, 12 weeks
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Occupation ratio
Time Frame: baseline, 6 weeks, 12 weeks
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AHD and STT will be combined in the occupation ratio to report how much space is occupied in the subacromial space, represented by the AHD, by the supraspinatus tendon.
It is in percentage.
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baseline, 6 weeks, 12 weeks
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Global perceived effect (GPE)
Time Frame: 1 week, 6 weeks, 12 weeks
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It is measured on a 7-Likert Scale, ranging from 1 (way much better) to 7 (way much worse); higher scores mean worst global perceived effect.
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1 week, 6 weeks, 12 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Filip Struyf, Professor, Universiteit Antwerpen
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 (Actual)
November 28, 2019
Primary Completion (Actual)
May 14, 2020
Study Completion (Actual)
May 14, 2020
Study Registration Dates
First Submitted
October 25, 2019
First Submitted That Met QC Criteria
November 4, 2019
First Posted (Actual)
November 6, 2019
Study Record Updates
Last Update Posted (Actual)
July 28, 2023
Last Update Submitted That Met QC Criteria
July 27, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18/34/379
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
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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