Effectiveness of physiotherapy and costs in patients with clinical signs of shoulder impingement syndrome: One-year follow-up of a randomized controlled trial
Thilo O. Kromer, Rob A. de Bie, Caroline H.G. Bastiaenen
School of Therapeutic Sciences, Department of Physiotherapy, SRH University Heidelberg, Heidelberg, The Netherlands.
Objectives: To investigate the effect of manual physiotherapy and exercises compared with exercises alone in patients with shoulder impingement syndrome one year after inclusion.
Design: Randomized controlled trial.
Subjects: Patients with shoulder impingement of more than 4 weeks.
Methods: The intervention group received individualized manual physiotherapy plus individualized exercises; the control group received individualized exercises only. Both groups had 10 treatments over 5 weeks; afterwards all patients continued their exercises for another 7 weeks at home. Primary outcomes were the Shoulder Pain and Disability Index and Patients’ Global Impression of Change. The Generic Patient-Specific Scale was used as secondary outcome. Costs were recorded in a log-book.
Results: Ninety patients were included in the study and 87 could be analyzed at 1-year follow-up. Both groups showed significant improvements in all outcome measures, but no difference was detected between the groups. Only costs differed significantly in favour of the control group (p = 0.03) after 5 weeks.
Conclusion: Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year. Exercises should therefore be considered as a basic treatment. Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months.
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