scholarly journals Return to work after subacromial decompression, diagnostic arthroscopy, or exercise therapy for shoulder impingement: a randomised, placebo-surgery controlled FIMPACT clinical trial with five-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mathias Bäck ◽  
Mika Paavola ◽  
Pasi Aronen ◽  
Teppo L. N. Järvinen ◽  
Simo Taimela ◽  
...  
Keyword(s):  
Return To Work ◽  
Exercise Therapy ◽  
Impingement Syndrome ◽  
Shoulder Impingement Syndrome ◽  
Subacromial Decompression ◽  
Shoulder Impingement ◽  
Diagnostic Arthroscopy ◽  
Arthroscopic Subacromial Decompression ◽  
Time Point

Abstract Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. Results There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). Conclusions Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either. Trial registration ClinicalTrials.gov identifier NCT00428870.

scholarly journals Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial

2020 ◽  
Vol 55 (2) ◽  
pp. 99-107
Author(s):  
Mika Paavola ◽  
Kari Kanto ◽  
Jonas Ranstam ◽  
Antti Malmivaara ◽  
Jari Inkinen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Exercise Therapy ◽  
Group Differences ◽  
Shoulder Impingement Syndrome ◽  
Subacromial Decompression ◽  
Shoulder Impingement ◽  
Diagnostic Arthroscopy ◽  
The Mean ◽  
Secondary Outcomes

ObjectivesTo assess the long-term efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy (primary comparison), a placebo surgical intervention, and with a non-operative alternative, exercise therapy (secondary comparison).MethodsWe conducted a multicentre, three group, randomised, controlled superiority trial. We included 210 patients aged 35–65 years, who had symptoms consistent with shoulder impingement syndrome for more than 3 months. 175 participants (83%) completed the 5 years follow-up. Patient enrolment began on 1 February 2005 and the 5-year follow-up was completed by 10 October 2018. The two primary outcomes were shoulder pain at rest and on arm activity measured with Visual Analogue Scale (VAS). Minimally important difference (MID) was set at 15. We used a mixed-model repeated measurements analysis of variance with participant as a random factor, the baseline value as a covariate and assuming a covariance structure with compound symmetry.ResultsIn the primary intention to treat analysis (ASD vs diagnostic arthroscopy), there were no between-group differences that exceeded the MID for the primary outcomes at 5 years: the mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were −2.0 (95% CI −8.5 to 4.6; p=0.56) at rest and −8.0 (−17.3 to 1.3; p=0.093) on arm activity. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. In our secondary comparison (ASD vs exercise therapy), the mean differences between groups (ASD minus exercise therapy) in pain VAS were 1.0 (−5.6 to 7.6; p=0.77) at rest and −3.9 (−12.8 to 5.1; p=0.40) on arm activity. There were no significant between-group differences for the secondary outcomes or adverse events.ConclusionsASD provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.

scholarly journals Comparison of exercise therapy and ultrasonic therapy in the treatment of shoulder impingement syndrome

2021 ◽  
Vol 9 (3) ◽  
pp. 3825-3833
Author(s):  
Bhargava Shanker ◽  
◽  
D. Rajesh Reddy ◽  
N.S.S.N. Balaji ◽  
◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Exercise Therapy ◽  
Simple Random Sampling ◽  
Impingement Syndrome ◽  
Shoulder Impingement Syndrome ◽  
Ultrasonic Therapy ◽  
Shoulder Impingement ◽  
Persistent Symptoms ◽  
Group I ◽  
Group 2

Background: The shoulder is one of the most frequent sites of musculoskeletal pain, incidence of shoulder pain in primary care patients is estimated to be 11.2 per 1000 per year. a considerable number of people with shoulder pain (41%) show persistent symptoms after 1 year. Comparing the exercise therapy and ultrasound therapy (UST) for impingement syndrome. Methodology: The study was conducted at OPD of MNR Hospital in Sangareddy. The study was conducted for a period of 3 weeks. A total number of 30 subjects were selected by simple random sampling after explained to all the participants and an informed consent was taken from each subject. 30 subjects were randomly divided into 2 Groups. Exercise therapy was given to Group 1 and UST was given to Group 2. Both the Groups received exercise therapy and ultrasonic therapy in shoulder impingement syndrome. Subjects were evaluated pre and post treatment for VAS (Visual Analogue Scale) score, SPADI SCORE (Shoulder Pain and disability index) shoulder ROM. Outcome measures: VAS scale, SPADI score. Results and Discussion: To test the significance of the mean difference of two groups, unpaired t test was done. It is statistically shown that there is some significant impact in the parameters VAS, SPADI and shoulder ROM. The results showed that, group-I had more significant improvement in all parameters than group –II. Conclusion: It is concluded that exercise therapy is better than ultrasonic therapy for subjects with shoulder impingement syndrome. KEY WORDS: Exercise Therapy, Ultrasonic Therapy, Shoulder Pain and disability index, Range of Motion.

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