针对肩峰下撞击综合征成人患者的特定运动方案与一般运动方案：一项随机对照试验
Specific versus general exercise programme in adults with subacromial impingement syndrome: a randomised controlled trial.
作者信息
Gutiérrez Espinoza Héctor, Araya-Quintanilla Felipe, Pinto-Concha Sebastian, Valenzuela-Fuenzalida Juan, López-Gil José Francisco, Ramírez-Velez Robinson
机构信息
Escuela de Fisioterapia, Universidad de las Americas, Quito, Ecuador.
Escuela de Kinesiología, Facultad de Odontología y Ciencias de la Salud, Universidad San Sebastián, Santiago, Chile.
出版信息
BMJ Open Sport Exerc Med. 2023 Sep 27;9(3):e001646. doi: 10.1136/bmjsem-2023-001646. eCollection 2023.
OBJECTIVES
Current evidence on the clinical effectiveness about the different types of exercises in the subacromial impingement syndrome (SIS) remains controversial. This study aims to compare the short-term (at 5 weeks) effects of a specific exercise programme with a general exercise programme on shoulder function in adults with SIS.
METHODS
In total, 52 adults with SIS were randomly allocated to 5 weeks to perform specific exercises (experimental group, n=26) or general exercises (control group, n=26). The primary outcome was change in shoulder function, it was assessed using the Shoulder Pain and Disability Index (SPADI) from baseline to 5 weeks. Secondary end points included changes in upper limb function (Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire), pain intensity (Visual Analog Scale (VAS)) and kinesiophobia (Tampa Scale of Kinesiophobia (TSK)).
RESULTS
All participants completed the trial. The between-group differences at 5 weeks were: SPADI, 13.5 points (95% CI: 4.3 to 15.6; ƞ=0.22; p=0.001); DASH, 10.1 points (95% CI: 5.6 to 15.2; ƞ=0.27; p<0.001); VAS at rest, 0.2 cm (95% CI: 0.1 to 0.3; ƞ=0.07; p=0.553); VAS on movement, 1.7 cm (95% CI: 0.9 to 2.2; ƞ=0.24; p<0.001); and TSK, 16.3 points (95% CI: 13.2 to 15.3; ƞ=0.33; p<0.001). All differences favoured the experimental group and effect sizes were medium to large for most outcomes. Mediation analyses showed that the effect of the specific exercises on shoulder function was mediated by kinesiophobia (β=2.800; 95% CI: 1.063 to 4.907) and pain on movement (β= -0.690; 95% CI: -1.176 to -0.271).
CONCLUSION
In adults with SIS, specific exercises may have a larger effect than general exercises. However, most differences did not reach the minimum threshold to be considered clinically important and the evidence to support exercise as standard treatment warrant further study.
TRIAL REGISTRATION NUMBER
Brazilian Registry of Clinical Trials UTN number U111-1245-7878. Registered on 17 January 2020 (https://ensaiosclinicos.gov.br/rg/RBR-4d5zcg).
目的
目前关于不同类型运动对肩峰下撞击综合征（SIS）临床疗效的证据仍存在争议。本研究旨在比较特定运动方案与一般运动方案对成年SIS患者肩部功能的短期（5周时）影响。
方法
总共52例成年SIS患者被随机分配，进行5周的特定运动（实验组，n = 26）或一般运动（对照组，n = 26）。主要结局是肩部功能的变化，从基线到5周使用肩痛和功能障碍指数（SPADI）进行评估。次要终点包括上肢功能的变化（手臂、肩部和手部功能障碍问卷（DASH））、疼痛强度（视觉模拟量表（VAS））和运动恐惧（坦帕运动恐惧量表（TSK））。
结果
所有参与者均完成试验。5周时组间差异为：SPADI，13.5分（95%CI：4.3至15.6；ƞ = 0.22；p = 0.001）；DASH，10.1分（95%CI：5.6至15.2；ƞ = 0.27；p < 0.001）；静息时VAS，0.2 cm（95%CI：0.1至0.3；ƞ = 0.07；p = 0.553）；运动时VAS，1.7 cm（95%CI：0.9至2.2；ƞ = 0.24；p < 0.001）；TSK，16.3分（95%CI：13.2至15.3；ƞ = 0.33；p < 0.001）。所有差异均有利于实验组，且大多数结局的效应大小为中等至较大。中介分析表明，特定运动对肩部功能的影响通过运动恐惧（β = 2.800；95%CI：1.063至4.907）和运动时疼痛（β = -0.690；95%CI：-1.176至-0.271）介导。
结论
在成年SIS患者中，特定运动可能比一般运动有更大的效果。然而，大多数差异未达到被认为具有临床重要性的最小阈值，且支持将运动作为标准治疗的证据有待进一步研究。
试验注册号
巴西临床试验注册中心UTN编号U111 - 1245 - 7878。于2020年1月17日注册（https://ensaiosclinicos.gov.br/rg/RBR - 4d5zcg）。
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