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肩峰撞击综合征单侧患者行肩峰下皮质类固醇注射与手动物理治疗的 1 年疗效比较：一项实用随机试验。

One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial.

出版信息

Ann Intern Med. 2014 Aug 5;161(3):161-9. doi: 10.7326/M13-2199.

Abstract

BACKGROUND

Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared.

OBJECTIVE

To compare the effectiveness of 2 common nonsurgical treatments for SIS.

DESIGN

Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891).

SETTING

Military hospital-based outpatient clinic in the United States.

PATIENTS

104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012.

INTERVENTION

Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy.

MEASUREMENTS

The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use.

RESULTS

Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, -6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, -2 to 1]) and pain rating (0.4 [CI, -0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported.

LIMITATION

The study occurred at 1 center with patients referred to physical therapy.

CONCLUSION

Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group.

PRIMARY FUNDING SOURCE

Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.

摘要

背景

皮质类固醇注射（CSIs）和物理治疗被用于治疗肩峰下撞击综合征（SIS）患者，但从未直接进行过比较。

目的

比较两种常见的非手术治疗 SIS 的效果。

设计

随机、单盲、比较有效性、平行组试验。（ClinicalTrials.gov：NCT01190891）。

地点

美国军事医院门诊。

患者

2010 年 6 月至 2012 年 3 月期间，104 例年龄在 18 至 65 岁之间的单侧 SIS 患者。

干预措施

随机分为两组：40mg 曲安奈德肩峰下 CSI 与 6 次手动物理治疗。

测量

主要结局为 1 年时的肩痛和残疾指数评分变化。次要结局包括总体变化评分、数字疼痛评分量表评分以及 1 年的医疗保健使用情况。

结果

两组患者的肩痛和残疾指数评分均改善约 50%，并持续至 1 年；然而，组间平均差异无统计学意义（1.5% [95%CI，-6.3%至 9.4%]）。两组患者的总体变化评分和疼痛评分均有所改善，但组间总体变化评分（0 [CI，-2 至 1]）和疼痛评分（0.4 [CI，-0.5 至 1.2]）的差异无统计学意义。在 1 年的随访期间，接受 CSI 的患者到初级保健提供者处进行 SIS 相关就诊的次数更多（60% vs. 37%），需要额外的类固醇注射（38% vs. 20%），19%需要物理治疗。CSI 引起的短暂疼痛是唯一报告的不良事件。