肩袖肌腱病患者进行三个月的渐进式高负荷与传统低负荷力量训练：双盲随机对照RoCTEx试验的主要结果
Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial.
作者信息
Ingwersen Kim Gordon, Jensen Steen Lund, Sørensen Lilli, Jørgensen Hans Ri, Christensen Robin, Søgaard Karen, Juul-Kristensen Birgit
机构信息
Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
Department of Physiotherapy, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark.
出版信息
Orthop J Sports Med. 2017 Aug 28;5(8):2325967117723292. doi: 10.1177/2325967117723292. eCollection 2017 Aug.
BACKGROUND
Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated.
PURPOSE
To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy.
STUDY DESIGN
Randomized controlled trial; Level of evidence, 1.
METHODS
Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population.
RESULTS
A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of -1.37 points (95% CI, -6.72 to 3.99; = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use ( = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid.
CONCLUSION
The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors.
REGISTRATION
NCT01984203 (ClinicalTrials.gov identifier): Rotator Cuff Tendinopathy Exercise Trial (RoCTEx).
背景
渐进性高负荷运动（PHLE）已在髌腱和跟腱病患者中取得了积极的临床效果。然而，其对肩袖肌腱病的影响仍有待研究。
目的
评估渐进性高负荷运动（PHLE）与低负荷运动（LLE）对肩袖肌腱病患者的临床效果。
研究设计
随机对照试验；证据等级为1级。
方法
招募肩袖肌腱病患者并随机分为接受12周渐进性高负荷运动（PHLE）或低负荷运动（LLE）的两组，根据是否同时给予皮质类固醇注射进行分层。主要结局指标是在意向性分析人群中，从基线到12周时手臂、肩部和手部功能障碍（DASH）问卷的变化。
结果
共有100例患者被随机分为渐进性高负荷运动（PHLE，n = 49）组或低负荷运动（LLE，n = 51）组。渐进性高负荷运动（PHLE）组和低负荷运动（LLE）组DASH问卷的平均变化分别为7.11分（95%CI，3.07 - 11.16）和8.39分（95%CI，4.35 - 12.44）；这相当于调整后的组间平均差异为-1.37分，差异无统计学意义（95%CI，-6.72至3.99；P = 0.61）。在疼痛、活动范围和力量方面也观察到类似的无显著差异结果。然而，发现两组与同时使用皮质类固醇之间存在显著的交互作用（P = 0.028），对于同时接受皮质类固醇治疗的组，DASH问卷中最大的正向变化有利于渐进性高负荷运动（PHLE）组。
结论
研究结果表明，在肩袖肌腱病患者中，渐进性高负荷运动（PHLE）并不比传统的低负荷运动（LLE）有更好的疗效。需要进一步研究运动类型与皮质类固醇注射之间可能的相互作用，以确定这两个因素的最佳和潜在协同组合。
注册信息
NCT01984203（ClinicalTrials.gov标识符）：肩袖肌腱病运动试验（RoCTEx）
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