EFFECTIVENESS OF PHYSIOTHERAPY AND COSTS IN PATIENTS WITH CLINICAL SIGNS OF SHOULDER IMPINGEMENT SYNDROME: ONE-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL.

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.