Physiotherapy and home exercise for chronic rotator cuff disease.

January 01, 0001

Physiotherapy and home exercise for chronic rotator cuff disease.

Rotator cuff injuries are common in primary care. This group of Australian researchers tested the efficacy of a program of manual therapy and exercise treatment compared delivered by physical therapists in patients with chronic rotator cuff issues in a randomized, participant and single assessor blinded, placebo controlled trial. The active treatment arm involved manual therapy and a home exercise program. The placebo treatment comprised inactive ultrasound therapy and application of an inert gel. Both arms had 10 sessions of individual standardized treatment over 10 weeks. In the following 12 weeks, the active group continued the home exercise program and the placebo group received no treatment.

The authors report: "112 (93 percent) participants completed the 22 week trial. At 11 weeks no difference was found between groups for change in shoulder pain and disability index (3.6) or change in pain (0.7). Both groups showed significant improvements. More participants in the active group reported a successful outcome (defined as 'much better'), although the difference was not statistically significant: 42 percent (24/57) of active participants and 30 percent (18/61) of placebo participants (relative risk 1.43). The active group showed a significantly greater improvement in shoulder pain and disability index than did the placebo group at 22 weeks (between group difference 7.1, 0.3 to 13.9), although no significant difference existed between groups for change in pain (0.9) or for the percentage of participants reporting a successful treatment outcome (relative risk 1.39). Several secondary outcomes favoured the active group, including shoulder pain and disability index function score, muscle strength, interference with activity, and quality of life."

The authors concluded: "A standardised programme of manual therapy and home exercise did not confer additional immediate benefits for pain and function compared with a realistic placebo treatment that controlled for therapists’ contact in middle aged to older adults with chronic rotator cuff disease. However, greater improvements were apparent at follow-up, particularly in shoulder function and strength, suggesting that benefits with active treatment take longer to manifest."

This randomized control trial for no early benefits and only modest longer term benefits of a standardized physical therapy routine and home exercise program.

For the full abstract, click here.

BMJ 340:c2756, 8 June 2010
© 2010 Bennell et al.
Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease- randomised placebo controlled trial. Kim Bennell, Elin Wee, Sally Coburn, et al. Correspondence to K Bennell: [email protected]

Category: M. Musculoskeletal. Keywords: rotator cuff, chronic rotator cuff tendonitis, physical therapy, home exercise, physiotherapy, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 2 July 2010

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