Background Exercise has been shown to be beneficial in the management of rotator cuff impingement syndrome (1,2). However, there is little evidence to support the use of exercise classes in the management of this condition.
Objectives The aim of this study was to assess if there was a difference between group and individual instruction of an exercise programme.
Methods 69 consecutive patients referred (from orthopaedic and rheumatology departments) for physiotherapy management of rotator cuff impingement syndrome participated. Patients were included if they had MRI confirmation of rotator cuff pathology or they had 3 positive of 5 impingement tests (3). Patients were excluded if they had a history of recent (previous 6 months) fracture/surgery or a diagnosis of shoulder instability or capsulitis. Prior to commencing the exercise programme Constant Murley score (CMS) and Quick DASH (QDASH) outcomes were performed. Patients were also instructed in posture correction and thoracic extension automobilisation.
Subject patients received instruction in groups of 4-6. Control patients received individual instruction. The exercise programme focussed on strengthening eccentric muscle activity in rotator cuff and scapular muscles (1). All patients attended fortnightly for 6 classes and exercises were progressed using the pain monitoring method. Patients performed the same exercises at home, twice daily for 8 weeks and once daily for 4 weeks. Measures were reassessed at 12 weeks.
Results 46 patients were reassessed, giving a 33% drop out rate. Baseline measurements were similar in both groups. The percentage change was greater in both outcomes for class/subject patients. Analysis using Student's T test showed no significant difference between groups for CMS (p=0.073) or for QDASH (p=0.107). ANCOVA (analysis of covariance) includes the baseline as a covariate reducing the overall error. ANCOVA indicates a significant difference between both groups for CMS (p=0.011) and QDASH (p=0.041) Cohen's d suggests a moderate effect size for both measures.
Conclusions Exercise classes for rotator cuff impingement syndrome have, at least, equivalent, and at best, better outcomes, in terms of pain, physical measurement and function, compared to individual instruction. The implications for time management and efficient use of resources make the class model an attractive and effective method for the management of rotator cuff impingement syndrome.
Holmgren T et al. Effect of a specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study BMJ (2012);344:e787doi:10.1136/bmj.e787
Kuhn J Exercise in the treatment of rotator cuff impingement: A systemic review and a synthesized evidence-based rehabilitation protocol J Shoulder Elbow Surg (2009) 18, 138-160
Michener et al Reliability and diagnostic Accuracy of 5 Physical Examination Tests and Combination of Tests for Subaccromial Impingement (2009) Arch Phys Med Rehabil (90)1898-1903
Acknowledgements Dr. Catherine Blake, School of Public Health, Physiotherapy and Populartion Science University College Dublin, Ireland
Disclosure of Interest None declared