High-dosage medical exercise therapy in patients with long-term subacromial shoulder pain: a randomized controlled trial.

Background And Purpose: Exercise therapy is a commonly used conservative therapy for long-term subacromial pain. However, there is no consensus regarding what type of exercises and dosage is most effective. The aim of this study was to compare the effect of two exercise programmes: 1) high-dosage (HD) medical exercise therapy versus 2) low-dosage (LD) exercise therapy programme for subjects with long-term subacromial pain.

Methods: This study used a randomized, controlled clinical trial with an intention-to-treat analysis. Sixty-one subjects were randomly assigned by concealment either to an HD medical exercise therapy group (n = 31) or to an LD exercise therapy group (n = 30). Pain (visual analogue scale [VAS]) and function (Shoulder Rating Questionnaire [SRQ]) were measured at inclusion, at end of treatment and at 6 and 12 months follow-up.

Results: There were no differences between groups at inclusion (baseline) regarding any variables. During the three months treatment period, five subjects (8%) dropped out, and another seven (11%) dropped out at one-year follow-up. At the end of treatment, both pain and function had improved significantly in favour of the HD therapy, between-group differences in VAS were -2.7 (-3.9 to 0.9), and for activity limitations, the between-group differences in the SRQ increased by 24.5 points (14.5-35.7). The differences between groups were both statistically and clinically significant at 6 and 12 months follow-up.

Conclusion: In subjects with long-term subacromial pain syndrome, HD medical exercise therapy is superior to a conventional LD exercise programme. For clinicians to obtain similar positive results with HD medical exercise therapy, factors such as good communication skills, constant close personal supervision during exercise treatment and having from three to five subjects in a group setting are important.