Chelsea and Westminster Hospital, London, UK.
J Physiother. 2012;58(2):127. doi: 10.1016/S1836-9553(12)70093-0.
Does a specific exercise program improve shoulder function more than non-specific exercises in patients with subacromial impingement?
Randomised, controlled trial with concealed allocation and blinded outcome assessment.
University hospital in Sweden.
Patients aged 30 to 65 years with subacromial impingement syndrome of at least 6 months duration, and on the waiting listing for surgery were included. Key exclusion criteria included previous shoulder fractures, and frozen shoulder. Randomisation of 102 participants allocated 52 to the intervention exercise group and 50 to a control exercise group.
Both groups received a subacromial corticosteroid injection at inclusion and commenced exercises 2 weeks later. Both groups visited a physiotherapist 7 times over 10 weeks and were prescribed home exercises for 12 weeks. The intervention exercise group were prescribed 6 exercises: 2 eccentric exercises for the rotator cuff, 3 concentric/ eccentric exercises for the scapula stabilisers, and a posterior shoulder stretch. Each strengthening exercise was repeated 15 times in 3 sets twice daily for 8 weeks and then once daily for 4 weeks. The stretch was completed for 30 to 60 seconds and repeated 3 times twice daily. Training load was progressed using weights or elasticised bands. The control group exercise program consisted of 6 non-specific movement exercises for the neck and shoulder (e.g. neck retraction, shoulder abduction). The control group exercises were not loaded or progressed and were completed 10 times 3 times daily.
The primary outcome was the Constant shoulder score at 3 months. The Constant score is scored from 0 to 100 with a higher score indicating better function. Secondary outcome measures included the disability of the arm, shoulder and hand questionnaire (DASH), a visual analogue score for pain, the EuroQol quality of life instrument, and whether the participant thought they still needed surgery.
97 participants completed the study. At 3 months, the change in Constant score was significantly more in the specific exercise group than the control group by 15 (95% CI 8.5 to 20.6) points. The DASH improved significantly more in the intervention than the control group by 8 (95% CI 2.3 to 13.7) points. The intervention group also improved significantly more than the control group in ratings of night pain, and quality of life. A lower proportion of the specific exercise group subsequently chose surgery (20% v 63%, Number Needed to Treat 3, 95% CI 1.6 to 3.9).
A specific, progressive exercise program focusing on training the rotator cuff and scapular stabilisers was effective in improving function, reducing pain and reducing the need of surgery for patients with chronic subacromial impingement syndrome. [Numbers needed to treat and 95% CIs calculated by the CAP Editor.].
对于肩峰下撞击综合征患者，特定的运动方案是否比非特定运动方案更能改善肩部功能？
随机对照试验，采用隐藏分组和盲法结局评估。
瑞典的一所大学医院。
年龄在 30 岁至 65 岁之间、肩峰下撞击综合征至少持续 6 个月且正在等待手术的患者被纳入研究。主要排除标准包括既往肩部骨折和冻结肩。102 名参与者随机分为干预运动组（52 名）和对照组（50 名）。
两组均在纳入时接受肩峰下皮质类固醇注射，并在 2 周后开始运动。两组均在 10 周内接受 7 次物理治疗师治疗，并接受 12 周的家庭运动治疗。干预运动组被开了 6 种运动：2 种针对肩袖的离心运动、3 种针对肩胛稳定器的向心/离心运动，以及 1 种后肩伸展运动。每组强化运动重复 15 次，每天 3 组，持续 8 周，然后每天 1 组，持续 4 周。伸展运动持续 30 至 60 秒，每天重复 3 次。训练负荷通过使用重量或弹性带来增加。对照组的运动方案包括 6 种针对颈部和肩部的非特定运动（如颈部回缩、肩部外展）。对照组的运动不进行负荷或进展，每天完成 3 次，每次 10 次。
主要结局是 3 个月时的 Constant 肩部评分。Constant 评分范围为 0 至 100，分数越高表示功能越好。次要结局指标包括手臂、肩部和手部残疾问卷（DASH）、疼痛视觉模拟评分、EuroQol 生活质量量表，以及参与者认为自己是否仍需要手术。
97 名参与者完成了研究。3 个月时，特定运动组的 Constant 评分变化明显优于对照组，差值为 15 分（95%CI 8.5 至 20.6）。干预组在 DASH 方面的改善明显优于对照组，差值为 8 分（95%CI 2.3 至 13.7）。与对照组相比，干预组在夜间疼痛和生活质量方面的评分也有显著改善。特定运动组中随后选择手术的比例明显低于对照组（20%比 63%，NNT 为 3，95%CI 1.6 至 3.9）。
针对肩袖和肩胛稳定器的特定、渐进式运动方案对慢性肩峰下撞击综合征患者的功能改善、疼痛减轻和手术需求减少均有效。[数字治疗效果（NNT）和 95%置信区间（CI）由 CAP 编辑计算。]
