The Effectiveness of Individual or Group Physiotherapy in the Management of Sub-Acromial Impingement: A Randomised Controlled Trial and Health Economic Analysis

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Abstract

Background: Shoulder pain is common in primary care. The management of subacromial
impingement (SAI) can include corticosteroid injections and physiotherapy. Physiotherapy can be
on an individual or group basis. Aim: To examine the clinical effectiveness and make an economic
analysis of individual versus group physiotherapy, following corticosteroid injection for SAI. Design
and Setting: A single-blind, open-label, randomised equivalence study comparing group and
individual physiotherapy. Patients referred by local general practitioners and physiotherapists were
considered for inclusion. Method: Patients were randomised to individual or group physiotherapy
groups, and all received corticosteroid injection before physiotherapy. The primary outcome
measure was shoulder pain and disability index (SPADI) at 26 weeks. An economic analysis was
conducted. Results and Conclusion: 136 patients were recruited, 68 randomised to each group.
Recruitment was 68% of the target 200 participants. SPADI (from baseline to 26 weeks)
demonstrated a difference (SE) in mean change between groups of −0.43 (5.7) (p-value = 0.050001)),
and the TOST (two-one-sided test for equivalence) 90% CI for this difference was (−10.0 to 9.14).
This was borderline. In a secondary analysis using inputted data, patients without SPADI at week
26 were analysed by carrying forward scores at week 12 (mean difference (95% CI) = −0.14 (−7.5 to
7.3), p-value = 0.014). There is little difference in outcome at 26 weeks. Group physiotherapy was
cheaper to deliver per patient (£252 versus £84). Group physiotherapy for SAI produces similar
clinical outcomes to individual physiotherapy with potential cost savings. Due to low recruitment
to our study, firm conclusions are difficult and further research is required to give a definitive
answer to this research question. (NCT Clinical Trial Registration Number NCT04058522.)
Original languageEnglish
JournalInternational Journal of Environmental Research and Public Health
DOIs
Publication statusPublished - 01 Aug 2020

Keywords

  • Shoulder pain
  • Subacromial impingement
  • Individual versus group Physiotherapy
  • Physiotherapy

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