Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial

Roddy, Edward; Ogollah, Reuben O; Oppong, Raymond; Zwierska, Irena; Datta, Praveen; Hall, Alison; Hay, Elaine; Jackson, Sue; Jowett, Sue; Lewis, Martyn; Shufflebotham, Julie; Stevenson, Kay; van der Windt, Danielle A; Young, Julie; Foster, Nadine E

Abstract

Objectives: To compare the clinical effectiveness of (1) physiotherapist-led exercise versus an exercise leaflet, and (2) ultrasound-guided subacromial corticosteroid injection versus unguided injection for pain and function in subacromial pain (formerly impingement) syndrome (SAPS).

Methods: This was a single-blind 2×2 factorial randomised trial. Adults with SAPS were randomised equally to one of four treatment groups: (1) ultrasound-guided corticosteroid injection and physiotherapist-led exercise, (2) ultrasound-guided corticosteroid injection and an exercise leaflet, (3) unguided corticosteroid injection and physiotherapist-led exercise and (4) unguided corticosteroid injection and an exercise leaflet. The primary outcome was the Shoulder Pain and Disability Index (SPADI), collected at 6 weeks, 6 and 12 months and compared at 6 weeks for the injection interventions and 6 months for the exercise interventions by intention to treat.

Results: We recruited 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months. Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months (adjusted mean difference -8.23; 95% CI -14.14 to -2.32). There were no significant differences between the injection groups at 6 weeks (-2.04; -7.29 to 3.22), 6 months (-2.36; -8.16 to 3.44) or 12 months (1.59; -5.54 to 8.72).

Conclusions: In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection.

Citation

Roddy, E., Ogollah, R. O., Oppong, R., Zwierska, I., Datta, P., Hall, A., Hay, E., Jackson, S., Jowett, S., Lewis, M., Shufflebotham, J., Stevenson, K., van der Windt, D. A., Young, J., & Foster, N. E. (2020). Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. British Journal of Sports Medicine, 1-11. https://doi.org/10.1136/bjsports-2019-101268

• Journal Article Type: Article
• Acceptance Date: Jun 19, 2020
• Online Publication Date: Aug 19, 2020
• Publication Date: Aug 19, 2020
• Deposit Date: Sep 23, 2020
• Publicly Available Date: Sep 23, 2020
• Journal: British Journal of Sports Medicine
• Print ISSN: 0306-3674
• Electronic ISSN: 1473-0480
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Pages: 1-11
• DOI: https://doi.org/10.1136/bjsports-2019-101268
• Keywords: exercise; physiotherapy; shoulder; steroids; ultrasound.
• Public URL: https://nottingham-repository.worktribe.com/output/4850798
• Publisher URL: https://bjsm.bmj.com/content/early/2020/08/19/bjsports-2019-101268