Shoulder Impingement Group: Does an Evidence-Based Approach Work?

Authors: JC Gibson, K Clay, K McLean

References: Presented at BESS 2008

The purpose of this prospective study was to assess the effectiveness of an evidence based exercise programme in the management of subacromial impingement syndrome.

Current evidence suggests that therapeutic exercise is an effective treatment in the management of Subacromial impingement syndrome, however, there is a lack of evidence with respect to what comprises an optimal exercise regime and which patients are most likely to benefit from an exercise based approach.

A two stage exercise programme was designed based on current consensus regarding the pathophysiology of Subacromial impingement syndrome and the guidelines proposed by the Chartered Society of Physiotherapists. 80 patients with a clinical diagnosis of subacromial impingement syndrome were entered into this prospective study. Patients received a one to one education session regarding their diagnosis and the basis of the exercise group. Patients attended for an average of 5 treatments (3 - 8) over a period of 12- 18 weeks. Frequency of attendance and longevity of treatment were determined by patient's rate of progress. Patients were instructed in a two stage exercise programme and were advised how to transfer movement pattern correction into their functional activities. Patients were assessed using the Oxford Shoulder Score and Quick Dash and a qualitative interview was performed on a random sample of patients post discharge.

81% of patients completing the class demonstrated a statistically significant improvement in all parameters. Patients demonstrating a positive scapula assistance test at their first assessment were 95% likely to respond to the exercise programme. There was a high non attendance rate in those patients with symptoms of short duration (< 6/52). Qualitative analysis revealed that key elements associated with a successful outcome were the one to one education session and understanding of diagnosis.

The evidence based exercise programme employed in the impingement group is an effective management strategy for patients with subacromial impingement syndrome.