Effectiveness of Radial Extracorporeal Shock Wave Therapy (rESWT) When Combined With Supervised Exercises in Patients With Subacromial Shoulder Pain: A Double-Masked, Randomized, Sham-Controlled Trial

Kvalvaag, Elisabeth; Brox, Jens Ivar; Engebretsen, Kaia Beck; Søberg, Helene Lundgaard; Juel, Niels Gunnar; Bautz‐Holter, Erik; Sandvik, Leiv; Røe, Cecilie

doi:10.1177/0363546517707505

Cited by 26 publications

(41 citation statements)

References 35 publications

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“…However, all eligible participants consented to participate in our study. This is similar to a Norwegian RCT among patients with subacromial pain, where only two out of 141 (1,5%) declined to participate (39). In a RCT with a calculated sample of approximately 150 patients, the present results indicate a recruitment period of 218 weeks (over 4 years) and screening of approximately 300 potentially eligible patients.…”

Section: Discussionsupporting

confidence: 84%

Adherence to Self-managed Exercises for Patients with Persistent Subacromial Pain: The Ad-Shoulder Feasibility Study

Major

Grotle

Littlewood

et al. 2020

Preprint

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Background: Exercise is recommended for patients with subacromial pain. It has been suggested that good exercise adherence improves clinical outcomes. Despite this, little attention has been paid to the need for behavioural frameworks to enhance adherence to home exercise programs for patients with subacromial pain.Methods: A feasibility study with pre-post design was used. Participants aged > 18 years, with subacromial pain, who had received conservative treatment during the past six months, were recruited. The Ad-Shoulder intervention consisted of 1-5 individual sessions provided over 3 months and was based on 5 self-management skills, which aimed to enhance the patients’ self-efficacy and adherence to self-managed exercises. The primary objectives were assessed according to predefined progression criteria: 1) The recruitment rate (10 patients enrolled within 12 weeks); 2) Follow-up rate (≥80% on all self-reported measures); 3) Objective physical activity measures (≥80% of participants would contribute valid data at each time point), 4) Adherence with the self-managed exercises (≥80% of the participants would adhere to ≥80% of the assigned home exercise program); 5) Fidelity of the delivery of the intervention (The therapists delivered the intervention according to the protocol); 6) Adverse events (<30% would report adverse events (including mild)). The results were reported using descriptive statistics.Results: Eleven patients were recruited during 16 weeks. Ten patients completed the self-reported measures at baseline and Week 12. Objective physical activity measures were successfully obtained for 100% at baseline, 64% at week six and 82% at week 12. 55% of the participants satisfactorily completed at least 80% of their home exercise program. All sessions were delivered according to the protocol. None of the patients reported any adverse events. Conclusions: Objective physical activity data measures at baseline and week 12, follow-up, the physiotherapists’ fidelity to the intervention and adverse events met our pre-specified progression criteria. Recruitment and adherence to the self-managed exercise program were both below the anticipated level. Further intervention development is necessary to understand whether adherence to the self-managed exercises could be enhanced and additional methods of recruitment would need to be considered, including additional recruitment sites, in any planning for a future main trial.Trial registration: ClinicalTrials.gov NCT04190836, Registered December 9, 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04190836

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Section: Discussionsupporting

confidence: 84%

Adherence to Self-managed Exercises for Patients with Persistent Subacromial Pain: The Ad-Shoulder Feasibility Study

Major

Grotle

Littlewood

et al. 2020

Preprint

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“…(25). In agreement to other authors, Kvalvaag et al (16) distinguished the non-calcific from the calcific and underlined that the improvement in the calcified is better (20). The test for overall effect, combining the results of the CMS and UCLA scores, showed an improvement of the shoulder joint function during the day living activities (p<0.05).…”

Section: Discussionsupporting

confidence: 87%

Effectiveness of Radial Shockwave Therapy in Calcific and Non-Calcific Tendinopathy of the Shoulder: a Systematic Review and Meta-Analysis

Ammendolia

Marotta

Demeco

et al. 2020

Muscle Ligaments and Tendons J

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Objective. To investigate RCTs that reported the effects of Radial ShockWave Therapy (RSWT) versus traditional physiotherapy on pain, shoulder articular function and quality of life of patients suffering by tendinopathy of the shoulder. Data sources. Studies were comprehensively searched, without language restrictions, on PubMed, Embase, PEdro, Cochrane Controlled Trials Register, the Cochrane. Possible studies from reference lists of articles and review were cross-checked. Study selection. Randomized controlled trials from 2006 to present were included. Two reviewers conducted the selection independently. Data extraction. Two reviewers assessed the quality of data. Disagreements in extraction were settled by consulting a third and fourth reviewers to reach a consensus. Data synthesis. Five studies with 475 participants were included in the network meta-analysis that used a random-effect model to investigate the mean difference of pooled effect sizes of the visual analog scale, Constant-Murley score combined with UCLA, and SPADI score. Conclusions. Compared to control groups, RSWT resulted an improvement in pain-0.24 (95% CI:-0.43 to-0.05 Z=2.45 p<0.05), an increase of Constant/UCLA score 4.72 (95% CI: 4.03 to 5.4 Z=13.5 p<0.05) and a decrease in SPADI scale-6.76 (95% CI:-13.3 to-0.48 Z=2.11 p<0.05). Despite the small number of the studies, seems that RSWT can be more effective in pain, shoulder articular function and quality of life of patients with tendinopathy of the shoulder.

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“…Thirdly, the study did not include a no treatment group. The traditional treatment has shown significant results from earlier 14,15,16 , but in this current study, it is not possible to decline the possibility of natural regression to have contributed to the overall improvement regarding pain and function.…”

Section: Study Limitationsmentioning

confidence: 61%

“…The patients in the traditional group were given treatment by a physical therapist, conducted one-toone, twice a week for 12 weeks, in addition to daily home-exercises. This is a program developed by at Ullevål University Hospital (now Oslo University Hospital) in the 1980s 13 , with a documented effect in earlier studies 14,15,16 .…”

Section: Traditional Supervised Exercisesmentioning

confidence: 99%

Feasibility of Heavy Slow Resistance Training in patients with subacromial shoulder pain. A single-blind, randomized pilot study.

Kvalvaag¹,

Høiland²,

Johnsen³

et al. 2020

Preprint

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Background: Subacromial shoulder pain is the most common shoulder diagnosis, and should preferably be treated non-operatively. Previous studies have shown promising results of Heavy Slow Resistance training (HSR) in patellar and Achilles tendinopathy, but few studies have evaluated the effect of HSR for shoulder pain. The purpose of this pilot trial was to evaluate if HSR training is feasible for patients with subacromial shoulder pain, and to compare HSR to traditional supervised exercises. Methods: Twenty-two patients with subacromial shoulder pain lasting at least three months were recruited and randomized to HSR (n=11) or traditional supervised exercises (n=11) by computer-generated randomization in blocks of four. Patients received HSR once a week, in addition to home-training twice a week, or supervised exercises twice a week for 12 weeks, in addition to daily home-training. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI). Linear regression analysis was applied to evaluate the between group differences after 12 weeks. Outcome assessors were masked. Results: After 12 weeks, patients in both groups had improved significantly from baseline in SPADI score (P=0.001) but no group difference was found (mean difference 1.3; 95% CI, -21.9 to 24.5, P=0.91). Similar non-significant results between groups were seen for pain in activity and rest, and the DASH score. Conclusion: This pilot-study observed similar results of HSR compared to supervised exercises for patients with subacromial shoulder pain and both groups improved significantly from baseline. Only one patient changed from HSR to supervised exercises due to increased pain. Based on this, HSR appears to be a feasible treatment for this patient group, but due to small sample size there is a risk of type II error and studies with larger sample size are required.

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Effectiveness of Radial Extracorporeal Shock Wave Therapy (rESWT) When Combined With Supervised Exercises in Patients With Subacromial Shoulder Pain: A Double-Masked, Randomized, Sham-Controlled Trial

Abstract: Radial ESWT offered no additional benefit to supervised exercises in the treatment of subacromial shoulder pain after 24 weeks, except in the subgroup of patients with calcification in the rotator cuff. Registration: NCT01441830 ( ClinicalTrials.gov identifier).

Cited by 26 publications

References 35 publications

Adherence to Self-managed Exercises for Patients with Persistent Subacromial Pain: The Ad-Shoulder Feasibility Study

Adherence to Self-managed Exercises for Patients with Persistent Subacromial Pain: The Ad-Shoulder Feasibility Study

Effectiveness of Radial Shockwave Therapy in Calcific and Non-Calcific Tendinopathy of the Shoulder: a Systematic Review and Meta-Analysis

Feasibility of Heavy Slow Resistance Training in patients with subacromial shoulder pain. A single-blind, randomized pilot study.

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