Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial.

Roddy, E; Ogollah, RO; Oppong, R; Zwierska, I; Datta, P; Hall, A; Hay, E; Jackson, S; Jowett, S; Lewis, M; Shufflebotham, J; Stevenson, K; Van Der Windt, DA; Young, J; Foster, NE

Abstract

OBJECTIVES: To compare the clinical effectiveness of (1) physiotherapist-led exercise versus an exercise leaflet, and (2) ultrasound-guided subacromial corticosteroid injection versus unguided injection for pain and function in subacromial pain (formerly impingement) syndrome (SAPS). METHODS: This was a single-blind 2×2 factorial randomised trial. Adults with SAPS were randomised equally to one of four treatment groups: (1) ultrasound-guided corticosteroid injection and physiotherapist-led exercise, (2) ultrasound-guided corticosteroid injection and an exercise leaflet, (3) unguided corticosteroid injection and physiotherapist-led exercise and (4) unguided corticosteroid injection and an exercise leaflet. The primary outcome was the Shoulder Pain and Disability Index (SPADI), collected at 6 weeks, 6 and 12 months and compared at 6 weeks for the injection interventions and 6 months for the exercise interventions by intention to treat. RESULTS: We recruited 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months. Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months (adjusted mean difference -8.23; 95% CI -14.14 to -2.32). There were no significant differences between the injection groups at 6 weeks (-2.04; -7.29 to 3.22), 6 months (-2.36; -8.16 to 3.44) or 12 months (1.59; -5.54 to 8.72). CONCLUSIONS: In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection. TRIAL REGISTRATION NUMBER: ISRCTN42399123.

Citation

Roddy, E., Ogollah, R., Oppong, R., Zwierska, I., Datta, P., Hall, A., …Foster, N. (2020). Optimising outcomes of exercise and corticosteroid injection in patients with subacromial pain (impingement) syndrome: a factorial randomised trial. British Journal of Sports Medicine, 55(5), https://doi.org/10.1136/bjsports-2019-101268

• Journal Article Type: Article
• Acceptance Date: Jun 19, 2020
• Publication Date: Aug 19, 2020
• Journal: British Journal of Sports Medicine
• Print ISSN: 0306-3674
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 55
• Issue: 5
• DOI: https://doi.org/10.1136/bjsports-2019-101268
• Publisher URL: https://bjsm.bmj.com/content/early/2020/08/19/bjsports-2019-101268