A novel evidence-based group exercise and education intervention for rotator cuff related shoulder pain: a pilot randomised controlled trial

Group exercise and education Participants randomised to the group exercise/education group will attend six fortnightly 60-minute group exercise/education sessions over 12 weeks at a single physiotherapy clinic. Participants will complete a total of three exercise sessions per week, including the 6 supervised sessions, with the remaining sessions to be completed independently at home. Prior to commencing the group exercise sessions, a single session of education (30 minutes) will be provided via a pre-recorded video sent to participants. The education session will include education regarding i) shoulder anatomy and causes of RCRSP and rotator cuff tendinopathy, ii) tissue changes are a normal part of healthy ageing, iii) factors that may worsen, or improve, shoulder pain and function, iv) monitoring pain during exercise and how much pain is acceptable, v) activity modification during activities of daily living and exercise, vi) prognosis, and vii) general physical activity recommendations. Prior to commencing group exercise classes, participants will attend a teleconference (Zoom) session where they will have an opportunity to ask questions. The video and teleconference session will be provided by a physiotherapist. Exercise fidelity will be assessed by audio recording sessions. There will be a maximum of four participants in each group. Group exercise will be supervised the same physiotherapist. The exercise program will be progressive and consist of shoulder exercises focusing on elevation, external rotation, pushing and pulling, using body weight, hand weights and resistance bands. Shoulder exercise will comprise of three sets of 15 repetitions and four seconds per cycle for isotonic exercise (two second concentric and two second eccentric phase) or six sets of 30 seconds if isometric exercise is commenced initially. Participants will progress through pre-determined levels of difficulty based on achieving the prescribed dosage (sets, repetitions, time under tension). Exercise difficulty and load will be progressed, or regressed, so that fatigue is achieved after the prescribed number of repetitions. The physiotherapist providing care will receive training from researchers (1 x 1.5 hour training session on site) in how to prescribe and monitor the exercises in a standardised way prior to the study commencing. Adherence to home-based exercise will be monitored with an exercise diary, completed by participants.