Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. Issue 5 (19th August 2020)

• Record Type: Journal Article
• Authors: Roddy, Edward; Ogollah, Reuben O; Oppong, Raymond; Zwierska, Irena; Datta, Praveen; Hall, Alison; Hay, Elaine; Jackson, Sue; Jowett, Sue; Lewis, Martyn; Shufflebotham, Julie; Stevenson, Kay; van der Windt, Danielle A; Young, Julie; Foster, Nadine E
• Is Part Of: British journal of sports medicine. Volume 55:Issue 5(2021)
• Page Start: 262
• Page End: 271
• Publication Date: 2020-08-19
• Subjects: shoulder -- physiotherapy -- exercise -- steroids -- ultrasound; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2019-101268
• Languages: English
• ISSNs: 0306-3674

Abstract

Abstract : Objectives: To compare the clinical effectiveness of (1) physiotherapist-led exercise versus an exercise leaflet, and (2) ultrasound-guided subacromial corticosteroid injection versus unguided injection for pain and function in subacromial pain (formerly impingement) syndrome (SAPS). Methods: This was a single-blind 2×2 factorial randomised trial. Adults with SAPS were randomised equally to one of four treatment groups: (1) ultrasound-guided corticosteroid injection and physiotherapist-led exercise, (2) ultrasound-guided corticosteroid injection and an exercise leaflet, (3) unguided corticosteroid injection and physiotherapist-led exercise and (4) unguided corticosteroid injection and an exercise leaflet. The primary outcome was the Shoulder Pain and Disability Index (SPADI), collected at 6 weeks, 6 and 12 months and compared at 6 weeks for the injection interventions and 6 months for the exercise interventions by intention to treat. Results: We recruited 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months. Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months (adjusted mean difference −8.23; 95% CI −14.14 to -2.32). There were no significant differences between the injection groups at 6 weeks (−2.04; −7.29 to 3.22), 6 months (−2.36; −8.16 to 3.44) or 12 months (1.59; −5.54 to 8.72). Conclusions: In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection. Trial registration number: ISRCTN42399123 .