Watanabe Akihisa, Ono-Matsukubo Qana, Nishigami Tomohiko, Maitani Toshiki, Mibu Akira, Hirooka Takahiko, Machida Hirohisa
Department of Rehabilitation, Machida Orthopedics, Kochi, Japan.
Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima, Japan.
Prog Rehabil Med. 2021 Apr 14;6:20210019. doi: 10.2490/prm.20210019. eCollection 2021.
Subacromial pain syndrome is a common problem in primary care. Although several randomized controlled trials have shown that eccentric exercise is effective in patients with subacromial pain syndrome, its generalizability to real-world clinical practice is unknown. This study aimed to investigate, using propensity score analysis, the generalizability of eccentric exercise for patients with subacromial pain syndrome to real-world daily clinical practice.
In this study, 78 patients underwent eccentric exercise in addition to traditional exercise, and 77 patients underwent only traditional exercise for 4 weeks. Outcomes measured using a visual analog scale (VAS) and American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment Form (ASES) scores were assessed at baseline and at 4 weeks.
In the propensity score-matched analysis, 65 patients in each group were successfully matched (130 of 155 patients, 84% overall). After 4 weeks of exercise, pain intensity was lower in the eccentric exercise group than in the traditional exercise group (VAS -14.5, 95% CI -21.2 to -7.9, P<0.001). No significant difference in the improvement in function was found between the two groups (ASES 4.1, 95% CI -2.0 to 10.2, P=0.18).
Eccentric and traditional exercise in combination could reduce pain in patients with subacromial pain syndrome to a greater extent than traditional exercise alone. These findings have clinical relevance to primary care practitioners who provide conservative treatment for patients with subacromial pain syndrome.
肩峰下疼痛综合征是初级保健中的常见问题。尽管多项随机对照试验表明，离心运动对肩峰下疼痛综合征患者有效，但其在现实临床实践中的可推广性尚不清楚。本研究旨在通过倾向得分分析，探讨离心运动对肩峰下疼痛综合征患者在现实日常临床实践中的可推广性。
在本研究中，78例患者除进行传统运动外还进行了离心运动，77例患者仅进行了4周的传统运动。在基线和4周时，使用视觉模拟量表（VAS）和美国肩肘外科医师协会标准化肩部评估表（ASES）评分来测量结果。
在倾向得分匹配分析中，每组65例患者成功匹配（155例患者中的130例，总体匹配率为84%）。运动4周后，离心运动组的疼痛强度低于传统运动组（VAS -14.5，95%可信区间 -21.2至 -7.9，P<0.001）。两组之间在功能改善方面未发现显著差异（ASES 4.1，95%可信区间 -2.0至10.2，P=0.18）。
与单独的传统运动相比，离心运动与传统运动相结合能更大程度地减轻肩峰下疼痛综合征患者的疼痛。这些发现对于为肩峰下疼痛综合征患者提供保守治疗的初级保健医生具有临床意义。
