Radial extracorporeal shockwave treatment compared with supervised exercises in patients with subacromial pain syndrome: single blind randomised study

Kaia Engebretsen, Margreth Grotle, Erik Bautz-Holter, Leiv Sandvik, Niels G Juel, Ole Marius Ekeberg, Jens Ivar Brox, Kaia Engebretsen, Margreth Grotle, Erik Bautz-Holter, Leiv Sandvik, Niels G Juel, Ole Marius Ekeberg, Jens Ivar Brox

Abstract

Objective: To compare the effectiveness of radial extracorporeal shockwave treatment with that of supervised exercises in patients with shoulder pain.

Design: Single blind randomised study.

Setting: Outpatient clinic of physical medicine and rehabilitation department in Oslo, Norway.

Participants: 104 patients with subacromial shoulder pain lasting at least three months.

Interventions: Radial extracorporeal shockwave treatment: one session weekly for four to six weeks. Supervised exercises: two 45 minute sessions weekly for up to 12 weeks. Primary outcome measure Shoulder pain and disability index.

Results: A treatment effect in favour of supervised exercises at 6, 12, and 18 weeks was found. The adjusted treatment effect was -8.4 (95% confidence interval -16.5 to -0.6) points. A significantly higher proportion of patients in the group treated with supervised exercises improved-odds ratio 3.2 (1.3 to 7.8). More patients in the shockwave treatment group had additional treatment between 12 and 18 weeks-odds ratio 5.5 (1.3 to 26.4).

Conclusion: Supervised exercises were more effective than radial extracorporeal shockwave treatment for short term improvement in patients with subacromial shoulder pain.

Trial registration: Clinical trials NCT00653081.

Conflict of interest statement

Competing interests: None declared.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787423/bin/engk605113.f1_default.jpg
Fig 1 Flow chart of study
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787423/bin/engk605113.f2_default.jpg
Fig 2 Mean shoulder pain and disability index scores with 95% confidence intervals for supervised exercises and radial extracorporeal shockwave treatment

References

    1. Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA. Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehabil 2006;16:7-25.
    1. Brox JI. Shoulder pain. Best Pract Res Clin Rheumatol 2003;17:33-56.
    1. Blaine TA, Kim YS, Voloshin I, Chen D, Murakami K, Chang SS, et al. The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg 2005;14(1 suppl S):84-9S.
    1. Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998;316:354-60.
    1. Bohmer A, Staff PH, Brox JI. Supervised exercises in relation to rotator cuff disease (impingement syndrome, stages 1 and II): a treatment regimen and its rationale. Physiother Theory Pract 1998;14:93-105.
    1. Harniman E, Carette S, Kennedy C, Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther 2004;17:132-51.
    1. Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther 2006;86:672-82.
    1. Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003;(1):CD004016.
    1. Hay EM, Thomas E, Paterson SM, Dziedzic K, Croft PR. A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care. Ann Rheum Dis 2003;62:394-9.
    1. Lombardi I Jr, Magri AG, Fleury AM, Da Silva AC, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum 2008;59:615-22.
    1. Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. Surgery for rotator cuff disease. Cochrane Database Syst Rev 2008;(1):CD005619.
    1. Unruh AM. Gender variations in clinical pain experience. Pain 1996;65:123-67.
    1. Zheng Z, Simpson JA, van der Windt D, Elliott AM. Data from a study of effectiveness suggested potential prognostic factors related to the patterns of shoulder pain. J Clin Epidemiol 2005;58:823-30.
    1. Speed CA, Richards C, Nichols D, Burnet S, Wies JT, Humphreys H, et al. Extracorporeal shock-wave therapy for tendinitis of the rotator cuff. J Bone Joint Surg Br 2002;84:509-12.
    1. Schmitt J, Haake M, Tosch A, Hildebrand R, Deike B, Griss P. Low-energy extracorporeal shock-wave treatment (ESWT) for tendinitis of the supraspinatus: a prospective, randomised study. J Bone Joint Surg Br 2001;83:873-6.
    1. Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome. J Hand Ther 2004;17:152-64.
    1. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005;87:1446-55.
    1. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res 1991;4:143-9.
    1. Ekeberg OM, Bautz-Holter E, Tveita EK, Keller A, Juel NG, Brox JI. Agreement, reliability and validity in 3 shoulder questionnaires in patients with rotator cuff disease. BMC Musculoskelet Disord 2008;9:68.
    1. Tveita EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord 2008;9:53.
    1. Brox JI, Staff PH, Ljunggren AE, Brevik JI. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ 1993;307:899-903.
    1. Triffitt PD, Wildin C, Hajioff D. The reproducibility of measurement of shoulder movement. Acta Orthop Scand 1999;70:322-4.
    1. Holm I, Friis A, Storheim K, Brox JI. Measuring self-reported functional status and pain in patients with chronic low back pain by postal questionnaires: a reliability study. Spine 2003;28:828-33.
    1. Virta L, Mortensen M, Eriksson R, Âller M. How many patients with subacromial impingement syndrome recover with physiotherapy? A follow-up study of a supervised exercise programme. Adv Physiother 2008;11:1-8.
    1. Gerdesmeyer L, Gollwitzer H, Diehl P, Wagner K. Radial extracorporeal shockwave therapy (rESWT) in orthopaedics. J Miner Stoffwechs 2004;11:36-9.
    1. Williams JW, Hollemann DR, Simmel DL. Measuring shoulder function with the shoulder pain and disability index. J Rheumatol 1995;22:727-32.
    1. Frison L, Pocock SJ. Repeated measures in clinical trials: analysis using mean summary statistics and its implications for design. Stat Med 1992;11:1685-704.
    1. Fitzmaurice GM. Applied longitudinal analysis. Hoboken, NJ: Wiley-Interscience, 2004.
    1. Guyatt GH, Juniper EF, Walter SD, Griffith LE, Goldstein RS. Interpreting treatment effects in randomised trials. BMJ 1998;316:690-3.
    1. Vickers AJ. Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC Med Res Methodol 2005;5:35.
    1. Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev 2003;(2):CD004258.
    1. Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wortler K, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA 2003;290:2573-80.
    1. De Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol 2006;59:1033-9.
    1. De Vet HC, Ostelo R, Terwee C, van der Roer N, Knol D, Beckerman H, et al. Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach. Qual Life Res 2007;16:131-42.

Source: PubMed

3
購読する