Hotta Gisele Harumi, Alaiti Rafael Krasic, Ribeiro Daniel Cury, McQuade Kevin James, de Oliveira Anamaria Siriani
Health Sciences Department, School of Medicine of Ribeirao Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, University of São Paulo, São Paulo, SP, Brazil.
Arch Physiother. 2022 Jun 1;12(1):13. doi: 10.1186/s40945-022-00138-1.
Causal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome.
Sixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome.
The results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability.
Scapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up.
因果中介分析是通过探索特定干预措施的因果途径来弥合这一差距的一种方法。本研究的目的是评估肩胛运动、位置和肩胛周围肌肉力量是否是针对肩峰下疼痛综合征患者进行肩胛稳定干预后疼痛和肩部功能障碍结果的中介因素。
60名患者被随机分为两组：肩胛稳定训练组或肩胛周围强化训练组。干预措施为每周进行3次训练，共8周。主要结局指标为疼痛和功能障碍，以下结局指标被视为潜在中介因素：肩胛运动、肩胛位置、肩胛周围肌肉力量、年龄、症状持续时间和患侧。采用基于模型的推理方法和自助模拟，从一项随机临床试验的数据中估计平均因果中介效应、平均直接效应和平均总效应，该试验评估了在肩胛胸廓强化训练计划中增加肩胛稳定训练对肩峰下疼痛综合征患者的影响。
结果表明，没有一个假定的中介因素受到干预的影响。然而，前锯肌、上、中、下斜方肌的肌肉力量与肩部功能障碍有关。
在肩峰下疼痛综合征患者中，肩胛运动学和肩胛周围肌肉力量并未介导肩胛稳定训练对肩部疼痛或功能障碍评分的影响。在8周随访时，前锯肌、上、中、下斜方肌的肌肉力量与肩部功能障碍评分有关。
