Shoulder Impingement Syndrome
Conditions
Keywords
Rehabilitation, Shoulder
Brief summary
This study evaluate the effectiveness of adding neuromuscular exercises with tactile, visual and auditory feedback to a scapula-focused treatment, both emphasizing the periscapular muscles on improvement of disability in patients with subacromial pain syndrome compared to patients receiving only strengthening exercise protocol.
Detailed description
Evidence of the effectiveness conservative treatments in shoulder impingement are in favor the application of specific exercises for scapulothoracic muscles and rotator cuff on pain reduction and improvement of upper limb function, supervised or performed at home, and these same exercises associated with other therapies promote a greater reduction in pain and improvement in disability. Currently, the evidence of better methodological quality present in the literature13 points out that the performance of motor control exercises focused on the scapula associated with mobilization and stretching generate pain improvement and clinically relevant improvement of the function. The few studies in this area have great methodological diversity with significant limitations. The hypothesis is that patients with subacromial pain syndrome who will receive traditional exercise protocol with the addition of neuromuscular training will show less functional disability, a greater reduction in pain intensity, increase muscle strength and range of motion when compared to the patient group that will receive only the protocol without neuromuscular training, immediately after the intervention, four and eight weeks and four months after randomization and that these benefits are clinically relevant.
Interventions
OTHERScapula-focused exercises
Sponsors
University of Sao Paulo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Diagnosis of subacromial pain syndrome with confirmed positivity in at least three of the five specific orthopedic impact tests: Neer test, Hawkins- Kennedy test, painful arc, external rotation resistance and empty can. Present history of pain in the shoulder lasting more than a week located in the proximal area of the shoulder
Exclusion criteria
* Subjects with a history of trauma or shoulder surgery, total rupture of the rotator cuff tendon and biceps, physically active involving the upper limbs or considered active accordance with the short version International Physical Activity Questionnaire (IPAQ). Subjects who have neurological diseases, referred pain in arms (indicative of involvement in the cervical or thoracic region), systemic disease involving the joints such as rheumatoid arthritis or fibromyalgia, the presence of disorders in the wrist such as carpal tunnel syndrome, and have done physical therapy in the shoulder the last six months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Functionality Evaluated With Specific Questionnaire | baseline, four and eight weeks and sixteen weeks after randomization | The Brazilian version of Shoulder Pain and Disability Index ranging 0 to 100 points. Lower scores indicate better functionality |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Intensity of Pain Evaluated by a Scale | baseline, four and eight weeks and sixteen weeks after randomization | Pain Numerical Rating Scale from 0 to 10. Lower values indicate improvement in pain |
| Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | baseline, four and eight weeks and sixteen weeks after randomization | Strength of serratus anterior, trapezius muscles, abduction, adduction, internal and external rotation movements the arm with hand held Dynamometer. |
| Perceived Change Evaluated by Numerical Scale | four, eight weeks and sixteen weeks of randomization | Global Perceived Effect Scale ranging -5 to +5 points. Positive values indicate improvement and negative values indicate worsening of symptoms |
| Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | baseline, four and eight weeks and sixteen weeks after randomization | abduction, adduction, internal and external rotation of the shoulder |
| Satisfaction With Treatment Evaluated With Specific Questionnaire | four, eight weeks and sixteen weeks after randomization | Medrisk Questionnaire ranging 13 to 80 points. High scores indicate satisfaction with treatment |
| Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | baseline, four and eight weeks and sixteen weeks after randomization | upward rotation and tilt of the scapula |
| Change in Kinesiophobia Evaluated With Specific Questionnaire | baseline, four and eight weeks and sixteen weeks after randomization | Tampa Scale of Kinesiophobia ranging 17 to 68 points. High scores indicate high degree kinesiophobia |
Countries
Brazil
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Scapula-focused Exercises Side lying external rotation, prone horizontal abduction , Scapular punch, Knee Push, Full can, D1 Diagonal, three times a week, 8 weeks, 3x10 repetitions
Scapula-focused exercises | 30 |
| Motor Control Exercises Towel slide, Scapular Clock, PNF scapular, Inferior Glide modified, Scapular Orientation Exercise, protraction and retraction of scapula, three times a week, 8 weeks, 3x10 repetitions
Scapula-focused exercises
Motor control exercises | 30 |
| Total | 60 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 0 | 1 |
| Overall Study | Lost to Follow-up | 3 | 2 |
Baseline characteristics
| Characteristic | Scapula-focused Exercises | Motor Control Exercises | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 30 Participants | 30 Participants | 60 Participants |
| Age, Continuous | 47 years STANDARD_DEVIATION 10 | 51 years STANDARD_DEVIATION 8 | 49 years STANDARD_DEVIATION 9 |
| Body mass index (kg/m^2) | 28.4 kg/m^2 STANDARD_DEVIATION 4.4 | 29.4 kg/m^2 STANDARD_DEVIATION 4.9 | 28.9 kg/m^2 STANDARD_DEVIATION 4.6 |
| Body mass (Kg) | 77 Kilograms STANDARD_DEVIATION 13.9 | 79.3 Kilograms STANDARD_DEVIATION 14.2 | 78.1 Kilograms STANDARD_DEVIATION 14 |
| Duration of symptoms (mo) | 28 months STANDARD_DEVIATION 15 | 29 months STANDARD_DEVIATION 33 | 28.8 months STANDARD_DEVIATION 26.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 30 Participants | 30 Participants | 60 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Height (m) | 1.64 meters STANDARD_DEVIATION 0.08 | 1.64 meters STANDARD_DEVIATION 0.07 | 1.64 meters STANDARD_DEVIATION 0.08 |
| Medication for pain | 24 Participants | 27 Participants | 51 Participants |
| Painful shoulder on the dominant side | 14 Participants | 18 Participants | 32 Participants |
| Region of Enrollment Brazil | 30 participants | 30 participants | 60 participants |
| Right hand Dominance | 30 Participants | 28 Participants | 58 Participants |
| Sex: Female, Male Female | 21 Participants | 21 Participants | 42 Participants |
| Sex: Female, Male Male | 9 Participants | 9 Participants | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 30 | 1 / 30 |
| other Total, other adverse events | 0 / 30 | 0 / 30 |
| serious Total, serious adverse events | 0 / 30 | 1 / 30 |
Outcome results
Primary
Change in Functionality Evaluated With Specific Questionnaire
The Brazilian version of Shoulder Pain and Disability Index ranging 0 to 100 points. Lower scores indicate better functionality
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Change in Functionality Evaluated With Specific Questionnaire | baseline | 63.3 units on a scale |
| Scapula-focused Exercises | Change in Functionality Evaluated With Specific Questionnaire | 4 weeks | 49.8 units on a scale |
| Scapula-focused Exercises | Change in Functionality Evaluated With Specific Questionnaire | 8 weeks | 37.1 units on a scale |
| Scapula-focused Exercises | Change in Functionality Evaluated With Specific Questionnaire | 16 weeks | 32.8 units on a scale |
| Motor Control Exercises | Change in Functionality Evaluated With Specific Questionnaire | 16 weeks | 34.2 units on a scale |
| Motor Control Exercises | Change in Functionality Evaluated With Specific Questionnaire | baseline | 65.7 units on a scale |
| Motor Control Exercises | Change in Functionality Evaluated With Specific Questionnaire | 8 weeks | 39.7 units on a scale |
| Motor Control Exercises | Change in Functionality Evaluated With Specific Questionnaire | 4 weeks | 43.5 units on a scale |
Secondary
Change in Intensity of Pain Evaluated by a Scale
Pain Numerical Rating Scale from 0 to 10. Lower values indicate improvement in pain
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Change in Intensity of Pain Evaluated by a Scale | Baseline | 3.7 units on a scale |
| Scapula-focused Exercises | Change in Intensity of Pain Evaluated by a Scale | 4 weeks | 2.7 units on a scale |
| Scapula-focused Exercises | Change in Intensity of Pain Evaluated by a Scale | 8 weeks | 1.8 units on a scale |
| Scapula-focused Exercises | Change in Intensity of Pain Evaluated by a Scale | 16 weeks | 0.5 units on a scale |
| Motor Control Exercises | Change in Intensity of Pain Evaluated by a Scale | 16 weeks | 1.2 units on a scale |
| Motor Control Exercises | Change in Intensity of Pain Evaluated by a Scale | Baseline | 3.9 units on a scale |
| Motor Control Exercises | Change in Intensity of Pain Evaluated by a Scale | 8 weeks | 1.3 units on a scale |
| Motor Control Exercises | Change in Intensity of Pain Evaluated by a Scale | 4 weeks | 1.5 units on a scale |
Secondary
Change in Kinesiophobia Evaluated With Specific Questionnaire
Tampa Scale of Kinesiophobia ranging 17 to 68 points. High scores indicate high degree kinesiophobia
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia baseline | 42.1 units on a scale |
| Scapula-focused Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 4 weeks | 39.8 units on a scale |
| Scapula-focused Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 8 weeks | 40.2 units on a scale |
| Scapula-focused Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 16 weeks | 38.7 units on a scale |
| Motor Control Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 16 weeks | 37.5 units on a scale |
| Motor Control Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia baseline | 42.8 units on a scale |
| Motor Control Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 8 weeks | 38.9 units on a scale |
| Motor Control Exercises | Change in Kinesiophobia Evaluated With Specific Questionnaire | Kinesiophobia 4 weeks | 40.7 units on a scale |
Secondary
Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF)
Strength of serratus anterior, trapezius muscles, abduction, adduction, internal and external rotation movements the arm with hand held Dynamometer.
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation baseline | 5.8 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 4 weeks | 7.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 8 weeks | 7.9 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 16 weeks | 7.8 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction baseline | 7.8 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 4 weeks | 8.8 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 8 weeks | 9.2 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 16 weeks | 8.5 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction baseline | 6.2 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 4 weeks | 5.9 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 8 weeks | 6.5 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 16 weeks | 6.9 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation baseline | 8.6 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 4 weeks | 9.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 8 weeks | 10.4 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 16 weeks | 10.3 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior Baseline | 7.2 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 4 weeks | 9.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 8 weeks | 10.3 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 16 weeks | 11.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius Baseline | 8.3 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 4 weeks | 9.8 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 8 weeks | 11.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 16 weeks | 11 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius Baseline | 4.4 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 4 weeks | 4.9 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 8 weeks | 5.1 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 16 weeks | 5.4 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius baseline | 4.3 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 4 weeks | 4.6 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 8 weeks | 5 Kilogram-force |
| Scapula-focused Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 16 weeks | 5 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 16 weeks | 4.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction baseline | 5.5 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior Baseline | 6.8 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 4 weeks | 6.3 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius Baseline | 3.3 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 8 weeks | 7.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 4 weeks | 10 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder abduction 16 weeks | 7 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius baseline | 3.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction baseline | 7.9 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 8 weeks | 10.8 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 4 weeks | 9 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 4 weeks | 4.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 8 weeks | 9.2 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Serratus Anterior 16 weeks | 10.6 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder adduction 16 weeks | 9 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 8 weeks | 4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation baseline | 5.7 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius Baseline | 8.8 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 4 weeks | 6.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 8 weeks | 4.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 8 weeks | 6.5 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 4 weeks | 11.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder external rotation 16 weeks | 6.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Lower Trapezius 4 weeks | 4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation baseline | 9.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 8 weeks | 12.1 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 4 weeks | 10.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Middle Trapezius 16 weeks | 4.6 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 8 weeks | 11.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Upper Trapezius 16 weeks | 11.4 Kilogram-force |
| Motor Control Exercises | Change in Strength Evaluated by Hand Held Dynamometer and the Measures Provided in Kilogram-force (KgF) | Shoulder Internal rotation 16 weeks | 10.7 Kilogram-force |
Secondary
Perceived Change Evaluated by Numerical Scale
Global Perceived Effect Scale ranging -5 to +5 points. Positive values indicate improvement and negative values indicate worsening of symptoms
Time frame: four, eight weeks and sixteen weeks of randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Perceived Change Evaluated by Numerical Scale | 4 weeks | 2 units on a scale |
| Scapula-focused Exercises | Perceived Change Evaluated by Numerical Scale | 8 weeks | 2.9 units on a scale |
| Scapula-focused Exercises | Perceived Change Evaluated by Numerical Scale | 16 weeks | 3.3 units on a scale |
| Motor Control Exercises | Perceived Change Evaluated by Numerical Scale | 4 weeks | 2.8 units on a scale |
| Motor Control Exercises | Perceived Change Evaluated by Numerical Scale | 8 weeks | 3.3 units on a scale |
| Motor Control Exercises | Perceived Change Evaluated by Numerical Scale | 16 weeks | 3.1 units on a scale |
Secondary
Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees
abduction, adduction, internal and external rotation of the shoulder
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion Baseline | 132.5 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 4 weeks | 140.4 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 8 weeks | 148 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 16 weeks | 146.6 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction Baseline | 125.3 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 4 weeks | 139 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 8 weeks | 147.8 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 16 weeks | 143.2 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation Baseline | 60.1 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 4 weeks | 66.4 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 8 weeks | 73.7 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 16 weeks | 71.4 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation Baseline | 49.2 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 4 weeks | 53.9 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 8 weeks | 59.2 degrees |
| Scapula-focused Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 16 weeks | 57.1 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 16 weeks | 54.8 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion Baseline | 129 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation Baseline | 60.9 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 4 weeks | 148.5 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation Baseline | 48.6 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 8 weeks | 147.8 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 4 weeks | 66.7 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Flexion 16 weeks | 149.9 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 8 weeks | 54.6 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction Baseline | 120.2 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 8 weeks | 68.3 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 4 weeks | 145.2 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Internal Rotation 4 weeks | 53.4 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 8 weeks | 145.5 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder External Rotation 16 weeks | 70 degrees |
| Motor Control Exercises | Range of Motion Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Shoulder Abduction 16 weeks | 141.3 degrees |
Secondary
Satisfaction With Treatment Evaluated With Specific Questionnaire
Medrisk Questionnaire ranging 13 to 80 points. High scores indicate satisfaction with treatment
Time frame: four, eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 4 weeks | 60.8 units on a scale |
| Scapula-focused Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 8 weeks | 61.3 units on a scale |
| Scapula-focused Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 16 weeks | 62 units on a scale |
| Motor Control Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 4 weeks | 63.1 units on a scale |
| Motor Control Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 8 weeks | 63.6 units on a scale |
| Motor Control Exercises | Satisfaction With Treatment Evaluated With Specific Questionnaire | Medrisk 16 weeks | 63.8 units on a scale |
Secondary
Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees
upward rotation and tilt of the scapula
Time frame: baseline, four and eight weeks and sixteen weeks after randomization
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 8 weeks | 15 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 4 weeks | 5.3 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 8 weeks | 5 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 16 weeks | 5.1 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º baseline | 12.8 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 4 weeks | 13.3 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º Baseline | 5.6 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 16 weeks | 16.8 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º baseline | 30.7 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 4 weeks | 37.3 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 8 weeks | 40.9 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 16 weeks | 39.7 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º baseline | 18.4 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 4 weeks | 18.4 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 8 weeks | 19.7 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 16 weeks | 18.7 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º baseline | 15 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 4 weeks | 14.6 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 8 weeks | 15.1 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 16 weeks | 13.2 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º baseline | 4.3 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 4 weeks | 2 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 8 weeks | 3.1 degrees |
| Scapula-focused Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 16 weeks | 0.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 8 weeks | 0.1 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º Baseline | 7 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º baseline | 19 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 4 weeks | 5.7 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 8 weeks | 12.3 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 8 weeks | 5.7 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 4 weeks | 19 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 0º 16 weeks | 6.5 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 4 weeks | 3.2 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º baseline | 13.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 8 weeks | 19.4 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 4 weeks | 14.5 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 16 weeks | 11.7 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 8 weeks | 17.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 0º 16 weeks | 19.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 90º 16 weeks | 20.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º 16 weeks | 0.7 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º baseline | 35.5 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º baseline | 14.2 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 4 weeks | 39.3 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 180º baseline | 4.2 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 8 weeks | 44.3 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Anterior Tilt 90º 4 weeks | 13.6 degrees |
| Motor Control Exercises | Scapula Position Evaluated by Digital Inclinometer and the Measures Provided in Degrees | Upward Rotation 180º 16 weeks | 44.5 degrees |