Patient-reported outcomes following a physiotherapy rehabilitation programme for atraumatic posterior shoulder subluxation

Blacknall, James; Mackie, A.; Wallace, W. Angus

doi:10.1177/1758573213517218

Cited by 16 publications

(28 citation statements)

References 24 publications

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“…Exercise was the most frequently cited treatment intervention reported by respondents for managing the clinical vignettes, which is supported by expert opinion and the limited research available supporting non-surgical management of ASI [ 27 , 30 , 48 – 50 ]. Interestingly, physiotherapists reported adapting their exercise approach depending upon the clinical scenario, aligning with expert recommendations [ 9 , 13 ] but in conflict with the evidence supporting the clinical effectiveness of standardised rehabilitation protocols [ 27 – 29 , 48 ].…”

Section: Discussionmentioning

confidence: 93%

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

Coulthard

Cairns

Williams

et al. 2021

BMC Musculoskelet Disord

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Background The impact of atraumatic shoulder instability (ASI) on patients can be extensive, its management complex, with a biopsychosocial approach recommended. Currently how physiotherapists manage ASI is unknown or the extent to which current clinical practice aligns with existing evidence. At the time of this study no national guidelines or consensus to direct practice existed. Methods A cross-sectional electronic survey was distributed between July-September 2018, targeting UK-based physiotherapists managing shoulder pathology. Respondents were invited to describe their management of ASI, and rate their awareness and utilisation of various treatment techniques on a Likert-scale; median and interquartile ranges were calculated. Free text survey items were analysed using quantitative content analysis (QCA) to identify codes and categories. Means and percentages were calculated to summarise QCA and descriptive data. Results Valid survey responses were analysed (n = 135). Respondents had between 2 and 39 years of physiotherapy experience (mean = 13.9 years); the majority (71.1 %) reported that ASI made up < 10 % of their caseload. Only 22.9 % (n = 31/135) of respondents reported feeling ‘very confident’ in managing ASI; the majority feeling ‘somewhat confident’ (70.4 %, n = 95/135) or ‘not confident’ (6.7 %, n = 9/135). The majority of respondents (59.3 %) used an ASI classification system, > 90 % citing the Stanmore Classification. Physiotherapists adapted their management according to clinical presentation, responding to differing biopsychosocial needs of the patient scenario. Most respondents (> 80 %) did not use a protocol to guide their management. Exercise was the most utilised management approach for ASI, followed by education; novel treatment strategies, including cortical rehabilitation, were also reported. Conclusion Findings indicate physiotherapists utilise a wide range of treatment strategies and respond to biopsychosocial cues when managing patients with ASI. The majority reported not being very confident in managing this condition, however only a minority use rehabilitation protocols to support their management. Some interventions that respondents reported using lacked evidence to support their use in ASI management and further research regarding effectiveness is required. Guidelines have been published since this survey; the impact of these will need evaluating to determine their effectiveness in the future.

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Section: Discussionmentioning

confidence: 93%

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

Coulthard

Cairns

Williams

et al. 2021

BMC Musculoskelet Disord

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“…The study will be powered to detect a between-group difference equal to or greater than a previously reported clinically important change of 252 points [ 40 , 63 ], with an SD for change from baseline to the 16-week follow-up of 350 points [ 16 , 22 ]. We expect both groups to experience a clinically relevant improvement, seen as a 48% improvement in the HEAVY group (equal to 504 points with an expected baseline mean score of 1050 points) comparable with effects of previous interventions [ 16 , 18 , 22 , 34 , 64 , 65 ] and 24% improvement in the LIGHT group [ 18 ] (equal to 252 points with an expected baseline mean score of 1050 points). With a two-sided significance level of 0.05 and 90% power, a sample size of 42 per group is required to detect a statistically significant difference.…”

Section: Interventionsmentioning

confidence: 93%

“…In the intention-to-treat and per-protocol analyses, missing data at follow-up will be accounted for by using a multiple imputation technique with age, sex, group allocation (masked), and baseline values as predictors. For sensitivity purposes, missing data will be imputed using a non-responder imputation, in which baseline values are carried forward [ 65 ]. The rationale builds on the assumption that participants who drop out will return to their baseline WOSI score [ 66 ].…”

Section: Methodsmentioning

confidence: 99%

A randomised controlled trial of heavy shoulder strengthening exercise in patients with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome and long-lasting shoulder complaints: study protocol for the Shoulder-MOBILEX study

Liaghat

Skou

Søndergaard

et al. 2020

Trials

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Background Four out of five patients with hypermobility spectrum disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS) experience shoulder complaints including persistent pain and instability. Evidence suggests that patients with HSD/hEDS who experience knee and back complaints improve with exercise-based therapy. However, no study has focused on exercise-based treatment for the shoulder in this patient group. The potential benefits of strengthening the shoulder muscles, such as increased muscle-tendon stiffness, may be effective for patients with HSD/hEDS who often display decreased strength and increased shoulder laxity/instability. The primary aim is to investigate the short-term effectiveness of a 16-week progressive heavy shoulder strengthening programme and general advice (HEAVY) compared with low-load training and general advice (LIGHT), on self-reported shoulder symptoms, function, and quality of life. Methods A superiority, parallel group, randomised controlled trial will be conducted with 100 patients from primary care with HSD/hEDS and shoulder complaints (persistent pain and/or instability) for more than 3 months. Participants will be randomised to receive HEAVY (full range of motion, high load) or LIGHT (neutral to midrange of motion, low load) strengthening programme three times weekly with exercises targeting scapular and rotator cuff muscles. HEAVY will be supervised twice weekly, and LIGHT three times during the 16 weeks. The primary outcome will be between-group difference in change from baseline to 16-week follow-up in the Western Ontario Shoulder Instability Index (WOSI, 0-2100 better to worse). Secondary outcomes will include a range of self-reported outcomes covering symptoms, function, and quality of life, besides clinical tests for shoulder strength, laxity/instability, and proprioception. Outcome assessors will be blinded to group allocation. Participants will be kept blind to treatment allocation through minimal information about the intervention content and hypotheses. Primary analyses will be performed by a blinded epidemiologist. Discussion If effective, the current heavy shoulder strengthening programme will challenge the general understanding of prescribing low-load exercise interventions for patients with HSD/hEDS and provide a new treatment strategy. The study will address an important and severe condition using transparent, detailed, and high-quality methods to potentially support a future implementation. Trial registration ClinicalTrials.gov NCT03869307. Registered on 11 March 2019.

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“…The number of participants receiving physiotherapy was approximately 491 ranging from 15 [27] to 85 [16]; one study reported the number of shoulders rather than participants [28]. The mean age of participants was similar between studies, ranging from 16 [29] to 25 years [28]. Proportions of female participants ranged from 53% [29] to 80% [17].…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability

et al. 2022

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Background Optimal physiotherapy treatment is uncertain for atraumatic shoulder instability (ASI), the primary aim of this systematic scoping review was to compare physiotherapy treatment programmes for people with ASI. The secondary aims were to evaluate outcome measures used and to compare the effectiveness of these programmes. Methods CINAHL, EMBASE and Medline databases were searched for studies, except single case studies, published between 1950 and July 2021. 12 critical appraisal items covered three domains; internal validity, transferability to wider population and reporting. Results Ten studies were included; one randomised controlled trial, 6 cohort studies and 3 case series. There were 491 participants. Treatment programmes included education, movement re-education, static posture correction, shoulder muscle strengthening, functional training, and adjuncts. All studies used patient reported outcome measures (PROMs), 7 of which reported a statistically significant improvement ( p < 0.05) post-treatment. There was no clear relationship between programmes and outcomes. PROMs specific to shoulder instability were all found to detect statistically significant differences post-treatment. Discussion There does not appear to be one optimal physiotherapy treatment programme for ASI. Future studies should use PROMs that are valid in the shoulder instability population and use more outcome measures that are specific to impairments being targeted.

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Patient-reported outcomes following a physiotherapy rehabilitation programme for atraumatic posterior shoulder subluxation

Abstract: Received

Cited by 16 publications

References 24 publications

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

Management of atraumatic shoulder instability in physiotherapy (MASIP): a survey of physiotherapy practice

A randomised controlled trial of heavy shoulder strengthening exercise in patients with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome and long-lasting shoulder complaints: study protocol for the Shoulder-MOBILEX study

A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability

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