(21-10-09) Supervised Exercises Beat Shock Waves for Relief of Shoulder Pain

Patients with subacromial shoulder pain who were treated with an exercise regimen had better short-term outcomes than did patients who had shock wave therapy in a single-blind, randomized Norwegian study.

In the 104-patient trial, individuals who had a supervised exercise regimen were three times as likely to show improvement on a pain and disability scale
at 6, 12, and 18 weeks as were patients treated with shock waves, study investigators reported online Sept. 16 in BMJ.

The study group consisted of 104 patients (52 men, 52 women) who had shoulder
pain lasting at least 3 months. All participants were recruited at the
outpatient clinic of the physical medicine and rehabilitation department of Ullev?l University Hospital, Oslo. Inclusion criteria were ?dysfunction or pain on abduction, normal passive glenohumeral range of motion, pain on two of three isometric tests (abduction at 0 degrees or 30 degrees, external or internal rotation), and a positive Kennedy-Hawkins sign,? wrote the investigators.
Exclusion criteria included instability, bilateral shoulder pain, and
rheumatoid arthritis or previous surgery on the affected shoulder.

Investigators randomized the 104 patients to either supervised exercises (two 45-minute sessions per week for a maximum of 12 weeks) or radial extracorporeal shock wave treatment (one session per week for 4-6 weeks) using the Swiss
DolorClast system (Electro Medical Systems SA). The patients? mean ages were 49 years (exercise group) and 47 years (shock wave group).

Follow-up was performed at 6, 12, and 18 weeks. The primary outcome was a
shoulder pain and disability index (SPADI), which was a self-reported score consisting of five questions on pain and eight questions on disability.
Patients used a visual analog scale to answer the questions, with a total score ranging from 0 (best) to 100 (worst). Secondary outcomes included work status, use of drugs, level of pain the week before follow-up, and active range of motion.

Analysis showed that the exercise group was significantly more likely than was the shock wave group to have an improved SPADI score (odds ratio 3.2), wrote the investigators, led by Kaia Engebretsen, a physical therapist at the Ullev?l University Hospital (BMJ 2009;339:b3360 [doi:10.1136/bmj.b3360]).

The adjusted treatment effect was ?8.4 points on the SPADI scale. ?More patients in the shock wave treatment group had additional treatment between 12 and 18 weeks ? odds ratio 5.5,? the researchers added.

?After 18 weeks, supervised exercises were better than radial extracorporeal shock wave treatment in terms of the primary outcome variable ? the shoulder pain and disability index ? and one secondary outcome variable ? work status,? they said. ?We found no significant differences for the other secondary outcome variables.?

Limitations of the study included the lack of a placebo group. However, ?a previous trial reported that a supervised exercise regimen was superior to placebo, so we found it difficult to justify the inclusion of a placebo group,? they noted. Other limitations were the fact that a local anesthetic was not injected into the subacromial space to improve diagnostic accuracy, and the study may have been underpowered to detect differences in secondary outcomes.

The authors did not declare any conflicts of interest.

Source: univadis.it

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