Effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

Abstract

An operant behavioural and time-contingent graded exercise therapy program was developed to improve functional ability irrespective of pain experience in patients with chronic shoulder complaints. The clinical effectiveness of graded exercise therapy compared to usual care was evaluated in a randomised clinical trial. Assessments were carried out before and after 12 weeks of treatment. Performance of daily activities was measured by two outcome measures: the main complaints instrument and the Shoulder Disability Questionnaire (SDQ). Patients were eligible for participation if they had suffered from shoulder complaints for at least three months. Patients suffering from systemic diseases, referred pain or severe biomedical or psychiatric disorders were excluded. Patients (n = 176) were randomised and allocated either to graded exercise therapy (n = 87) or usual care (n = 89). Graded exercise therapy led to greater improvement in the performance of daily activities than usual care. However, only mean differences between groups in performance of activities related to the main complaints reached statistical significance (p = 0.049; 95% CI 0.0 to 15.0). The observed beneficial effects were considered to be small to moderate (calculated effect sizes: 0.30 for the main complaints instrument and 0.07 for the SDQ). Subgroup analysis showed larger improvements on the mean complaints instrument in patients not reporting pain reduction over time. Graded exercise therapy seems to be less effective in restoring performance of daily activities as assessed by the SDQ in patients showing a painful arc during physical examination. Results showed that graded exercise therapy is more effective in restoring the ability to daily activities in patients with chronic shoulder complaints than usual care, although beneficial effects are small.

Pain in chronic fatigue syndrome: response to rehabilitative treatments in the PACE trial

“…Physical activity (as compared to sustained sedentary behaviour) appears important in the central nervous system's regulation of pain in fibromyalgia, a condition closely related to and commonly co-morbid with CFS (Ellingson et al 2012). GET is a moderately effective treatment for several pain disorders beyond CFS (Geraets et al 2005;George et al 2010). The differences in approach between APT and GET highlight the importance of a graded approach to increasing physical activity for improving outcomes for chronic pain.…”

Manual Physical Therapy in the Netherlands: Reflecting on the Past and Planning for the Future in an International Perspective

“…Research in patients with lumbosacral radiculopathy 42 , shoulder pain 43 , and pelvic pain 44 has shown no between-group differences in pain-related fear between graded activity and usual care groups. The new insights into the basic science underlying chronic pain imply that we should instead be comparing graded exposure to activities associated with pain-related fear to this current standard protocol of graded physical activity.…”

Occupational Therapy Interventions for Shoulder Conditions: A Systematic Review

“…A comparison of exercise groups with the control group showed significant reductions in visual analog scale pain at present and at worst in the exercise groups, offering limited evidence to support the efficacy of exercise programs to reduce pain in work-related trapezius myalgia. Geraets et al (2005) compared graded exercise therapy with usual care, including information, recommendations, and pain control on an as-needed basis. The authors described graded exercise therapy as a behavioral program based on graded activity, time contingency, and operant conditioning.…”