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The aim of this study is to evaluate the efficacy of 12 weeks of sensorimotor training with movement representation techniques for reducing pain intensity in people with rotator cuff related shoulder pain, relative to standard care. Besides, the secondary aim of this study is to explore the mechanisms underlying the effects of central mechanism treatment in people with rotator cuff related shoulder pain. A total of 122 older adults aged 50 or above with the presence of shoulder pain for more than three months will be recruited and randomized into 12-weeks of movement representation techniques with sensorimotor training vs. standard care. Shoulder pain and disability Index (SPADI), changes in primary motor cortex (M1) using brain MRI, changes in subacromial space using ultrasound imaging, Widespread Pain Index (WPI), Pain Catastrophising Scale (PCS), and Fear-avoidance Beliefs questionnaires (FABQ) will be assessed at baseline and 12-week post intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | No Intervention | Wait-list control | |
| Intervention | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sensorimotor training with movement representation techniques | Other | Sensorimotor training will be implemented with movement representation techniques using a standardized retraining sequence of a shoulder control exercise during arm elevation with 3 phases: Phase 1: Action Observation Training; Phase 2: Mirror therapy; and Phase 3: Sensorimotor training of the involved arm. Each session will last 60 minutes, with one supervised intervention session over the 12 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain intensity | Pain will be assessed using the pain sub-score of the Chinese Version of the Shoulder Pain and Disability Index. It is a validated self-administered questionnaire used to evaluate upper limb symptoms and functional limitations during daily activities. The questionnaire consists of 13 items with two subscales, i.e., pain intensity (five items) and disability (eight items), and each subscale-item will be summed to obtain a pain-score and a disability-score. The total of all items will be summed to obtain the final scores for each domain ranging from 0 to 100, with higher scores indicating more pain and disability. In the present study, the pain sub-score will be used as the measure of average pain intensity. | Baseline and 12-weeks post-intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Cortical thickness in the primary motor cortex (M1) using brain MRI | The brain structure will be measured using structural and resting-state functional magnetic resonance imaging (fMRI) on a 3.0 T Siemens Prisma scanner. During the resting-state scan, the participants will be instructed to rest with their eyes closed while remaining stationary for 30 minutes. The regional cortical thickness of the brain region, the primary motor cortex (M1), will be extracted from T1-weighted MRI images. |
| Measure | Description | Time Frame |
|---|---|---|
| Shoulder strength | The isokinetic testing of shoulder rotational strength will be measured using a Cybex Norm isokinetic dynamometer | Baseline and 12-weeks post-intervention |
| Subacromial space | The subacromial space will be scanned using an ultrasound scanning system during arm resting at 0° and static arm holding at 60° of shoulder abduction. The subacromial space will be measured from the tangential distance between the humeral head and the infero-lateral edge of the acromion. Three measurements will be recorded and the averaged value will be calculated. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Annie LEONG | Contact | 85227666707 | annie-ht.leong@polyu.edu.hk |
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| Baseline and 12 weeks post-intervention |
| Baseline and 12-weeks post-intervention |
| Central pain processing | The Widespread Pain Index will be adopted to capture features of central sensitisation. It quantifies the extent of bodily pain on a 0-19 scale, assessing whether patients have pain in 19 different body regions, each point scores 1. All items will be summed to obtain a final score ranging from 0 to 100, with higher scores indicating more widespread pain. | Baseline and 12-weeks post-intervention |
| Pain Catastrophising | The Chinese version of the Pain Catastrophising Scale will be used to assess pain catastrophising. This is a validated self-administered questionnaire consisting of 13-items examining pain-related behaviours and cognition. Scores range from 0 to 52, with higher scores indicating a higher level of catastrophising. | Baseline and 12-weeks post-intervention |
| Fear-avoidance Beliefs questionnaires | The Chinese version of the Fear-avoidance Beliefs questionnaires is a self-administered questionnaire consisting of 16 items with 2 subscales that evaluate fear avoidance beliefs about physical activity and work. Each item is scored from 0 to 6, representing completely disagree to completely agree. The total score is calculated by the summation of the individual scores of each item, from 0 to 96, with higher scores indicating a higher degree of fear avoidance belief. | Baseline and 12-weeks post-intervention |