Effectiveness of video-based rehabilitation program on pain, functionality, and quality of life in the treatment of rotator cuff tears: A randomized controlled trial

Türkmen, Ezgi; Akbaba, Yıldız Analay; Altun, Süleyman

doi:10.1016/j.jht.2019.08.004

Cited by 17 publications

(41 citation statements)

References 26 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Hopewell

Keene

Heine

et al. 2021

Health Technol Assess

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Background Rotator cuff-related shoulder pain is very common, but there is uncertainty regarding which modes of exercise delivery are optimal and the long-term benefits of corticosteroid injections. Objectives To assess the clinical effectiveness and cost-effectiveness of progressive exercise compared with best-practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. Design This was a pragmatic multicentre superiority randomised controlled trial (with a 2 × 2 factorial design). Setting Twenty NHS primary care-based musculoskeletal and related physiotherapy services. Participants Adults aged ≥ 18 years with a new episode of rotator cuff-related shoulder pain in the previous 6 months. Interventions A total of 708 participants were randomised (March 2017–May 2019) by a centralised computer-generated 1 : 1 : 1 : 1 allocation ratio to one of four interventions: (1) progressive exercise (n = 174) (six or fewer physiotherapy sessions), (2) best-practice advice (n = 174) (one physiotherapy session), (3) corticosteroid injection then progressive exercise (n = 182) (six or fewer physiotherapy sessions) or (4) corticosteroid injection then best-practice advice (n = 178) (one physiotherapy session). Main outcome measures The primary outcome was Shoulder Pain and Disability Index (SPADI) score over 12 months. Secondary outcomes included SPADI subdomains, the EuroQol 5 Dimensions, five-level version, sleep disturbance, fear avoidance, pain self-efficacy, return to activity, Global Impression of Treatment and health resource use. Outcomes were collected by postal questionnaires at 8 weeks and at 6 and 12 months. A within-trial economic evaluation was also conducted. The primary analysis was intention to treat. Results Participants had a mean age of 55.5 (standard deviation 13.1) years and 49.3% were female. The mean baseline SPADI score was 54.1 (standard deviation 18.5). Follow-up rates were 91% at 8 weeks and 87% at 6 and 12 months. There was an overall improvement in SPADI score from baseline in each group over time. Over 12 months, there was no evidence of a difference in the SPADI scores between the progressive exercise intervention and the best-practice advice intervention in shoulder pain and function (adjusted mean difference between groups over 12 months –0.66, 99% confidence interval –4.52 to 3.20). There was also no difference in SPADI scores between the progressive exercise intervention and best-practice advice intervention when analysed at the 8-week and 6- and 12-month time points. Injection resulted in improvement in shoulder pain and function at 8 weeks compared with no injection (adjusted mean difference –5.64, 99% confidence interval –9.93 to –1.35), but not when analysed over 12 months (adjusted mean difference –1.11, 99% confidence interval –4.47 to 2.26), or at 6 and 12 months. There were no serious adverse events. In the base-case analysis, adding injection to best-practice advice gained 0.021 quality-adjusted life-years (p = 0.184) and increased the cost by £10 per participant (p = 0.747). Progressive exercise alone was £52 (p = 0.247) more expensive per participant than best-practice advice, and gained 0.019 QALYs (p = 0.220). At a ceiling ratio of £20,000 per quality-adjusted life-year, injection plus best-practice advice had a 54.93% probability of being the most cost-effective treatment. Limitations Participants and physiotherapists were not blinded to group allocation. Twelve-month follow-up may be insufficient for identifying all safety concerns. Conclusions Progressive exercise was not superior to a best-practice advice session with a physiotherapist. Subacromial corticosteroid injection improved shoulder pain and function, but provided only modest short-term benefit. Best-practice advice in combination with corticosteroid injection was expected to be most cost-effective, although there was substantial uncertainty. Future work Longer-term follow-up, including any serious adverse effects of corticosteroid injection. Trial registration Current Controlled Trials ISRCTN16539266 and EudraCT 2016-002991-28. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 48. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

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

Hopewell

Keene

Heine

et al. 2021

Health Technol Assess

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Corticosteroid injections and physiotherapy exercise programmes are commonly used to treat rotator cuff disorders but the treatments' effectiveness is uncertain. We aimed to compare the clinical effectiveness and costeffectiveness of a progressive exercise programme with a single session of best practice physiotherapy advice, with or without corticosteroid injection, in adults with a rotator cuff disorder.Methods In this pragmatic, multicentre, superiority, randomised controlled trial (2 × 2 factorial), we recruited patients from 20 UK National Health Service trusts. We included patients aged 18 years or older with a rotator cuff disorder (new episode within the past 6 months). Patients were excluded if they had a history of significant shoulder trauma (eg, dislocation, fracture, or full-thickness tear requiring surgery), neurological disease affecting the shoulder, other shoulder conditions (eg, inflammatory arthritis, frozen shoulder, or glenohumeral joint instability), received corticosteroid injection or physiotherapy for shoulder pain in the past 6 months, or were being considered for surgery. Patients were randomly assigned (centralised computer-generated system, 1:1:1:1) to progressive exercise (≤6 sessions), best practice advice (one session), corticosteroid injection then progressive exercise, or corticosteroid injection then best practice advice. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score over 12 months, analysed on an intention-to-treat basis (statistical significance set at 1%). The trial was registered with the International Standard Randomised Controlled Trial Register, ISRCTN16539266, and EuDRACT, 2016-002991-28.Findings Between March 10, 2017, and May 2, 2019, we screened 2287 patients. 708 patients were randomly assigned to progressive exercise (n=174), best practice advice (n=174), corticosteroid injection then progressive exercise (n=182), or corticosteroid injection then best practice advice (n=178). Over 12 months, SPADI data were available for 166 (95%) patients in the progressive exercise group, 164 (94%) in the best practice advice group, 177 (97%) in the corticosteroid injection then progressive exercise group, and 175 (98%) in the corticosteroid injection then best practice advice group. We found no evidence of a difference in SPADI score between progressive exercise and best practice advice when analysed over 12 months (adjusted mean difference -0•66 [99% CI -4•52 to 3•20]). We also found no evidence of a difference between corticosteroid injection compared with no injection when analysed over 12 months (-1•11 [-4•47 to 2•26]). No serious adverse events were reported.Interpretation Progressive exercise was not superior to a best practice advice session with a physiotherapist in improving shoulder pain and function. Subacromial corticosteroid injection provided no long-term benefit in patients with rotator cuff disorders.

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“…A further 70 articles were removed based on the screening of abstracts. After screening of full texts, 17 prospective randomised controlled trials were included within this review [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. A summary of the elimination process can be found in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trials

Sayampanathan¹,

Tan²,

Lie³

2021

AJA

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Rotator cuff tears are known to result in significant societal burden. This review synthesises the evidence regarding the role and outcomes of conservatively managed rotator cuff tears. 17 prospective randomised controlled trials (RCTs) (Level 1 and 2 studies) were included in this systematic review. Modalities which were studied were classified into physical rehabilitative modalities, electrophysiological rehabilitative modalities, biological therapies, and pharmacologic therapies. Outcomes which were evaluated in the included RCTs comprised of clinical outcomes, functional outcomes, pain scores, quality of life scores, imaging based outcomes, and patient satisfaction scores. As the modalities and outcomes studied were varied, no quantitative analysis could be performed based on the primary data available. Nevertheless, most studies do suggest that conservative treatment remains beneficial for the management of rotator cuff tears. Based on these findings, an algorithm which proposes conservative therapy as the central mode of management for rotator cuff tear patients has been described. More high-quality studies are required in this area of study to allow for a quantitative review (meta-analysis and meta-regression) of the various non-surgical treatment modalities of rotator cuff tears. Keywords: Rotator Cuff Tears; Conservative; Non-operative; Management; Randomised controlled trials; Review.

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Effectiveness of video-based rehabilitation program on pain, functionality, and quality of life in the treatment of rotator cuff tears: A randomized controlled trial

Cited by 17 publications

References 26 publications

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

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

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

Role And Outcomes of Conservative Treatment in Management of Rotator Cuff Tears: A Systematic Review of Randomised Controlled Trials

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