Guided exercises with or without joint mobilization or no treatment in patients with subacromial pain syndrome: A clinical trial

Abstract

Background: Graded resistance training is the recommended treatment for patients with subacromial pain syndrome. It is debated whether adding joint mobilization will improve the outcome. The aim of this study was to evaluate the clinical outcome of guided exercises with or without joint mobilization, compared with controls who did not receive any treatment.

Methods: A 3-armed controlled trial in a primary care setting. A total of 120 patients, with clinically diagnosed subacromial pain syndrome, were randomized into guided exercise groups with and without additional joint mobilization, and a control group that did not receive any treatment. Data were analysed at baseline, 6 weeks, 12 weeks and 6 months. Primary outcome was the Constant-Murley score, and secondary outcomes were pain and active range of motion.

Results: Shoulder function improved in all groups, as measured with the Constant-Murley score. At 12 weeks and 6 months the exercise groups improved significantly compared with the control group (p ≤ 0.05). Add-on joint mobilization resulted in decreased pain in active range of motion at 6 and 12 weeks compared with guided exercise or no treatment (p ≤ 0.05). Range of motion increased over time in all 3 groups.

Conclusion: In patients with subacromial pain syndrome guided exercises improved shoulder function compared with no treatment. Add-on joint mobilization decreased pain in the short-term compared with exercise alone or no treatment.

Keywords: Constant-Murley score; manual therapy; resistance training; shoulder pain.

Fig. 1

Two step randomization process. Step 1; one of three sequence lists were drawn to decide upon inclusion to control group (CG) and Step 2; randomization to Intervention groups (IG1, IG2)

Fig. 2

Flow-chart of the patients throughout the entire study reported following the recommendations of the Consolidated Standards of Reporting Trials (CONSORT).

Fig. 3

The Constant-Murley score at baseline, 6 weeks, 12 weeks and 6 months. The intervention group 1 (IG1) was significantly improved compared to the Control Group (CG) at 6 weeks, 12 weeks and 6 months and intervention group 2 (IG2) was improved at 12 weeks and 6 months. Exact values and mean differences with 95% confidence intervals are presented in Table II.

Fig. 4

The improvement in Constant-Murley score from baseline expressed as a change-score. The vertical bars denote 95% confidence interval (CI), and the mean differences between the control group (CG) and the intervention groups (IG1 and IG2) are significant at all points of measurement. Exact values and mean differences with 95% confidence intervals are presented in Table III. The intervention groups reaches clinically important change at 3 months (≥ 17p on C-M score) (28).

Fig. 5

Proportions of patients with pain at rest, in movement and at compression at the different evaluation times