Østerås Håvard, Torstensen Tom Arild, Østerås Berit
Department of Physical Therapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Ranheimsv 10, Trondheim, Norway.
Physiother Res Int. 2010 Dec;15(4):232-42. doi: 10.1002/pri.468.
Exercise therapy is a commonly used conservative therapy for long-term subacromial pain. However, there is no consensus regarding what type of exercises and dosage is most effective. The aim of this study was to compare the effect of two exercise programmes: 1) high-dosage (HD) medical exercise therapy versus 2) low-dosage (LD) exercise therapy programme for subjects with long-term subacromial pain.
This study used a randomized, controlled clinical trial with an intention-to-treat analysis. Sixty-one subjects were randomly assigned by concealment either to an HD medical exercise therapy group (n = 31) or to an LD exercise therapy group (n = 30). Pain (visual analogue scale [VAS]) and function (Shoulder Rating Questionnaire [SRQ]) were measured at inclusion, at end of treatment and at 6 and 12 months follow-up.
There were no differences between groups at inclusion (baseline) regarding any variables. During the three months treatment period, five subjects (8%) dropped out, and another seven (11%) dropped out at one-year follow-up. At the end of treatment, both pain and function had improved significantly in favour of the HD therapy, between-group differences in VAS were -2.7 (-3.9 to 0.9), and for activity limitations, the between-group differences in the SRQ increased by 24.5 points (14.5-35.7). The differences between groups were both statistically and clinically significant at 6 and 12 months follow-up.
In subjects with long-term subacromial pain syndrome, HD medical exercise therapy is superior to a conventional LD exercise programme. For clinicians to obtain similar positive results with HD medical exercise therapy, factors such as good communication skills, constant close personal supervision during exercise treatment and having from three to five subjects in a group setting are important.
运动疗法是长期肩峰下疼痛常用的保守治疗方法。然而，对于哪种类型的运动及剂量最为有效尚无共识。本研究旨在比较两种运动方案的效果：1）高剂量（HD）医学运动疗法与2）低剂量（LD）运动疗法对长期肩峰下疼痛患者的效果。
本研究采用随机对照临床试验及意向性分析。61名受试者通过隐蔽随机分组，分为HD医学运动疗法组（n = 31）或LD运动疗法组（n = 30）。在入组时、治疗结束时以及6个月和12个月随访时测量疼痛（视觉模拟量表[VAS]）和功能（肩部评分问卷[SRQ]）。
在入组（基线）时，两组在任何变量上均无差异。在三个月的治疗期内，5名受试者（8%）退出，另有7名（11%）在一年随访时退出。治疗结束时，HD疗法组的疼痛和功能均有显著改善，VAS组间差异为-2.7（-3.9至0.9），对于活动受限，SRQ组间差异增加了24.5分（14.5 - 35.7）。在6个月和12个月随访时，组间差异在统计学和临床上均有显著意义。
在长期肩峰下疼痛综合征患者中，HD医学运动疗法优于传统的LD运动方案。临床医生要通过HD医学运动疗法获得类似的积极效果，良好的沟通技巧、运动治疗期间持续密切的个人监督以及每组三至五名受试者等因素很重要。
