Heron Stuart R, Woby Steve R, Thompson Dave P
Department of Physiotherapy, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB, United Kingdom.
Department of Research and Development, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB, United Kingdom.
Physiotherapy. 2017 Jun;103(2):167-173. doi: 10.1016/j.physio.2016.09.001. Epub 2016 Sep 21.
OBJECTIVES: To assess the efficacy of three different exercise programmes in treating rotator cuff tendinopathy/shoulder impingement syndrome. DESIGN: Parallel group randomised clinical trial. SETTING: Two out-patient NHS physiotherapy departments in Manchester, United Kingdom. PARTICIPANTS: 120 patients with shoulder pain of at least three months duration. Pain was reproduced on stressing the rotator cuff and participants had full passive range of movement at the shoulder. INTERVENTIONS: Three dynamic rotator cuff loading programmes; open chain resisted band exercises (OC) closed chain exercises (CC) and minimally loaded range of movement exercises (ROM). MAIN OUTCOMES: Change in Shoulder Pain and Disability Index (SPADI) score and the proportion of patients making a Minimally Clinically Important Change (MCIC) in symptoms 6 weeks after commencing treatment. RESULTS: All three programmes resulted in significant decreases in SPADI score, however there were no significant differences between the groups. Participants making a MCIC in symptoms were similar across all groups, however more participants deteriorated in the ROM group. Dropout rate was higher in the CC group, but when only patients completing treatment were considered more patients in the CC group made a meaningful reduction in pain and disability. CONCLUSIONS: Open chain, closed chain and range of movement exercises all seem to be effective in bringing about short term changes in pain and disability in patients with rotator cuff tendinopathy. ISRCTN76701121.
目的：评估三种不同运动方案治疗肩袖肌腱病/肩部撞击综合征的疗效。 设计：平行组随机临床试验。 地点：英国曼彻斯特的两个国民保健服务体系（NHS）门诊物理治疗科。 参与者：120例肩部疼痛至少持续三个月的患者。在对肩袖施加压力时会再现疼痛，且参与者肩部被动活动范围正常。 干预措施：三种动态肩袖负荷方案；开链抗阻带练习（OC）、闭链练习（CC）和最小负荷活动范围练习（ROM）。 主要结局：治疗开始6周后，肩痛和功能障碍指数（SPADI）评分的变化以及症状出现最小临床重要变化（MCIC）的患者比例。 结果：所有三种方案均导致SPADI评分显著降低，但各组之间无显著差异。所有组中症状出现MCIC的参与者相似，但ROM组中更多参与者病情恶化。CC组的退出率更高，但仅考虑完成治疗的患者时，CC组中有更多患者的疼痛和功能障碍有显著减轻。 结论：开链、闭链和活动范围练习似乎都能有效使肩袖肌腱病患者短期内的疼痛和功能障碍发生改变。国际标准随机对照试验编号：ISRCTN76701121。
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