Group versus individual treatment for rotator cuff tendinopathy: A randomised clinical trial in Primary care.
Karina Teahan, Deirdre Kiely, Sinead Lynch, Noreen Walsh, Dr Mark Phelan
HSE Cork Kerry Community Healthcare (Primary Care) South Infirmary Victoria University Hospital, Cork
Exercise-based treatment has been shown to be effective for rotator cuff tendinopathy/subacromial impingement syndrome. Research has shown that group-based versus individual physiotherapy results in similar outcomes, in terms of pain & disability, when delivering exercise interventions for musculoskeletal disorders (O’Keeffe et al, 2017).
The primary aim of this trial is to investigate whether group exercise is as effective as multi-modal one-to-one physiotherapy using the Shoulder Pain and Disability Index (SPADI) QuickDASH, the Constant-Murley score (CMS) and the Patient Global Impression of Change (GIC) to assess changes in pain and disability at 6 weeks, 3 months and 6 months.
A single-blinded randomised trial was undertaken. 69 patients (49 women, 20 men) with shoulder rotator cuff tendinopathy were recruited from the waiting list of a primary care physiotherapy department, screened for eligibility and provided informed consent to participate in the study. Participants were randomised into the group exercise or usual care arms of the study. Baseline measures (SPADI,QuickDASH and CMS) were administered by an independent assessor blind to the group allocation. These measures plus the GIC were reassessed at 6 weeks, 12 weeks and 6 months. The usual care group received physiotherapy according to their therapist’s discretion. The group intervention consisted of 12 sessions (twice weekly for 6 weeks) of a 1 hour circuit-type exercise class.
69 eligible participants were recruited (35 to group and 34 to individual care), of which 60 completed the trial. Mean duration of shoulder pain was 15.2 months (SD=21.7) and mean age was 64.3 (SD=15.1). Both groups achieved a statistically and clinically significant level of change in SPADI at 6 weeks (p<0.001 within group) and 6 months follow-up (p<0.001 within group). There was no statistically significant between-group difference at either time-point (p=0.92 at 6 weeks, p=0.69 at 6 months). Similar trends were noted for each of the other outcome measures.
There was no difference in outcome for patients with rotator cuff tendinopathy managed either with group or individual physiotherapy. This study supports the use of group-based exercise for management of rotator cuff tendinopathy in a primary care setting as an effective and potentially more resource efficient service.