Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction:
Shoulder pain is incredibly common among the general population with a prevalence of between 7-26%. Most of this shoulder pain is attributed to the generalized term of Subacromial pain syndrome (SAPS), subacromial impingement syndrome, rotator cuff tendinopathy, or some other variant of these. This dysfunction is traditionally linked to overuse or dysfunction of underlying structures in the area of glenohumeral joint, altered kinematics of the shoulder, or slouched posture. This meta-analysis looks to compare patient treatment outcomes when they take part in an intensive supervised exercise program, a home training program, and no training at all.
Methods:
The systematic review included studies with populations of non-traumatic event related shoulder pain with pain lasting at least 1 month before seeking professional help and no other clear diagnosis at hand. Supervised training was defined as training instructed by a healthcare professional two or more times. Home Training included a take home leaflet from a healthcare professional or one time instruction, but no other instruction, and no training received was no instruction at all and were left to heal without therapy. The study lengths ranged from being 6 weeks to 6 months long and used multiple patient reporting handouts to determine patient pain and functionality.
Conclusions of the Study:
The review determined that having supervised training was better than no training at all and improved pain at rest and during movement, shoulder function, and patient perceived effect. However, supervised training and home training had equal effects on pain and shoulder function. The researchers stated that supervised training saw greater benefits in patients with higher pain levels and disability levels at baseline, as well as greater adherence to the training protocol. This suggests that the clinician will have to use their clinical judgement to determine which patients will benefit from more of a home based exercise program, and which will require more in person supervision to recover from SAPS or other similar conditions.
Clinical Implications:
This paper gives insight to the necessity of a PT’s judgement when treating their patient’s. The improvements in pain and shoulder function patient’s receive from exercise can be seen regardless of whether it is supervised for multiple visits per week within clinic or unsupervised at home. The key is to take into account the patient’s stage of healing, irritability levels, baseline level of function, and attitude toward exercise to decide if they can make progress on their own. If the patient happens to be in a high irritability state incorporating several sessions of supervised therapy may be greatly beneficial to build the patient’s confidence and comfort with performing exercises on their own, in conjunction with manual techniques to desensitize the painful areas. This may allow the therapist to eventually transition the patient to a self-management home exercise program. The goal should be to educate and empower patients to understand the benefits of the exercise and be able to manage their own rehabilitation at home when treating individuals with SAPS or other similar conditions.
Reference:
Liaghat, B., Ussing, A., Petersen, B. H., Andersen, H. K., Barfod, K. W., Jensen, M. B., Hoegh, M., Tarp, S., Juul-Kristensen, B., & Brorson, S. (2021). Supervised training compared with no training or self-training in patients with Subacromial Pain Syndrome: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 102(12). https://doi.org/10.1016/j.apmr.2021.03.027