Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego

Abstract

Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care Background: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. Aim: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. Patients and Methods: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. Results: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. Conclusions: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

Progressive exercise compared with best-practice advice, with or without corticosteroid injection, for rotator cuff disorders: the GRASP factorial RCT

“…From an initial 2354 records, we identified seven trials 67,[110][111][112][113][114][115] published between 2013 and 2020, comparing the effects of supervised exercise with unsupervised exercise, or no intervention, in people with a rotator cuff disorder (excluding those who required surgery). Most of the trials concluded that there was little or no difference between supervised and unsupervised exercise.…”

“…The populations were comparable to the GRASP trial, with the exception of the trial by Krischak et al, 110 which evaluated people with atraumatic full-thickness rotator cuff tears. All trials were small, with the exception of the trial by Contreras et al 113 (n = 271) and the SUPPORT trial 115 [which had 64 participants in each group (2 × 2 factorial trial) and 256 participants in total]. Only two 67,115 of the seven trials reported on the effect of exercise on shoulder pain and function at 12 months, two reported medium-term follow-up data (24 or 26 weeks 111,113 ) and the remaining three trials reported outcomes at ≤ 6 weeks (see Appendix 6, Table 58).…”

“…All trials were small, with the exception of the trial by Contreras et al 113 (n = 271) and the SUPPORT trial 115 [which had 64 participants in each group (2 × 2 factorial trial) and 256 participants in total]. Only two 67,115 of the seven trials reported on the effect of exercise on shoulder pain and function at 12 months, two reported medium-term follow-up data (24 or 26 weeks 111,113 ) and the remaining three trials reported outcomes at ≤ 6 weeks (see Appendix 6, Table 58). This reinforces the importance of the GRASP trial findings in terms of their definitive nature and length of follow-up.…”

Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial

“…A Cochrane review published in 2016 highlighted insufficient evidence about the long-term effects of treatments offered by physiotherapists for rotator cuff disorders. 4 In our own systematic review we identified seven trials 24 , 25 , 26 , 27 , 28 , 29 , 30 between 2013 and 2020, comparing the effects of supervised versus unsupervised exercise, or no intervention, in people with a rotator cuff disorder. All the trials were small, apart from two moderate sized trials with 271 and 256 participants each, 28 , 30 and only two 26 , 30 reported on the effect of exercise on shoulder pain and function at 12 months, four reported medium-term follow-up data (4–6 months), and the remaining three reported outcomes at 6 weeks or less.…”

“… 4 In our own systematic review we identified seven trials 24 , 25 , 26 , 27 , 28 , 29 , 30 between 2013 and 2020, comparing the effects of supervised versus unsupervised exercise, or no intervention, in people with a rotator cuff disorder. All the trials were small, apart from two moderate sized trials with 271 and 256 participants each, 28 , 30 and only two 26 , 30 reported on the effect of exercise on shoulder pain and function at 12 months, four reported medium-term follow-up data (4–6 months), and the remaining three reported outcomes at 6 weeks or less. Most studies concluded little or no difference between supervised and unsupervised exercise at 6 months and 12 months, with the exception of the SUPPORT trial, 30 which showed a benefit of supervised exercise compared with a simple exercise leaflet at 6 months but not at 12 months.…”