Effectiveness of Physiotherapy for Chronic Shoulder Pain

Efficacy and Cost-effectiveness of Physiotherapy for Chronic Rotator Cuff Pathology

The purpose of this study is to investigate whether a physiotherapy program reduces pain and improves disability and quality-of-life in people with chronic shoulder pain.

The main study hypotheses are that (i) A 10-week physiotherapy treatment will result in significantly greater reductions in pain and disability than placebo treatment in individuals with chronic shoulder pain (ii) Improvements in pain and disability following a 10-week physiotherapy treatment will be maintained at a 3-month follow-up.

Chronic rotator cuff pathology (CRCP) is a common cause of musculoskeletal morbidity in the community. Physiotherapy is often the first line of management for this condition. However, the effectiveness of physiotherapy for CRCP has not been well studied. Thus this project primarily aims to investigate the effect of a multimodality physiotherapy program to treat CRCP where effect is measured in terms of pain, disability and health-related quality of life. The secondary aim is to evaluate the cost-effectiveness of physiotherapy as a treatment for CRCP.

Comparison: physiotherapy program comprising stretches, exercises, manual techniques versus placebo physiotherapy

Inclusion Criteria:

• diagnosis of CRCP as evident by symptoms and signs including pain on active abduction or external rotation and positive impingement test;
• symptoms of pain in shoulder for > 3 months;
• average movement pain > 3 on a 10 cm visual analogue scale;
• aged ≥ 18 years;
• able to understand written and spoken English.

Exclusion Criteria:

• severe pain at rest, defined as > 7 on a visual analogue scale;
• global restriction of shoulder movements;
• systemic inflammatory joint disease;
• x-ray evidence of shoulder osteoarthritis or fracture;
• calcification about the shoulder joint;
• reason to suspect a complete rotator cuff rupture (eg. weakness of arm elevation, a positive "drop arm sign", a high riding humerus visible on x-ray or a complete tear on ultrasound);
• previous shoulder surgery on affected arm;
• physiotherapy, corticosteroid injection or hydrodilatation for shoulder in past 3 months;
• commenced non-steroidal antiinflammatory medication (NSAIDs) or conservative intervention in past 2 weeks.