Supervised versus home exercise program in subacromial impingement syndrome: a randomized controlled trial with 1-year of follow-up.

OBJECTIVE

To compare the short- and long-term functional outcomes of a specific supervised exercise program with a general home exercise program for people with subacromial impingement syndrome (SIS).

METHODS

Ninety-four adults diagnosed with stage II SIS were randomly allocated to 12 weeks of either a specific supervised exercise program (n = 47) or a home exercise program (n = 47). The primary outcome was shoulder function, which was assessed using the Constant-Murley (CM) questionnaire. Secondary outcomes included scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Visual Analog Scale (VAS), Tampa Scale of Kinesiophobia (TSK), and level of irritability. All outcomes were assessed at baseline, after the 12-week intervention, and at the 1-year follow-up. For statistical analysis, analysis of covariance (ANCOVA) was performed.

RESULTS

All participants completed the trial. For the CM questionnaire, between-group differences were 25.2 points at 12 weeks (95% Confidence Interval [CI], 17.7-29.8; P < 0.001) and 31.5 points at 1 year (95% CI, 26.4-36.5; P < 0.001) in favor of the supervised exercise group. Similarly, at 12 weeks and 1 year, between-group differences in secondary outcomes were also statistically significant in favor of the supervised exercise group and surpassed the minimal clinically important difference threshold. Moreover, after 12 weeks, the percentage of participants who responded positively was significantly higher in the supervised exercise group (P< 0.001). Finally, exploratory analysis revealed that participants in the supervised exercise group showed better short- and long-term responses to treatment (P < 0.001).

CONCLUSIONS

After 12 weeks of intervention, and at the 1-year follow-up, a specific supervised exercise program was found to be more effective than a general home exercise program. Differences between groups exceeded minimum clinically important difference thresholds for all outcomes assessed, suggesting that the present results could be clinically important.

TRIAL REGISTRATION: Brazilian Registry of Clinical Trials UTN number U111-1204-0268.