title: A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial.
abstract: BACKGROUND
  Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined. Both early and late referrals have disadvantages - unnecessary operations and smaller improvements in shoulder function, respectively. This paper describes the design of a new interdisciplinary treatment strategy for SIS (TRANSIT), which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery.
  
  
  METHODS
  The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a randomized controlled trial (RCT). Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection. After inclusion they will receive injection treatment again by their general practitioner. When, after this treatment, there is a second recurrence within a year post-injection, the participants will be randomized to either an arthroscopic subacromial decompression (intervention group) or continuation of usual medical care (control group). The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems. At inclusion, at randomization and three, six and 12 months post-randomization an outcome assessment will take place. The primary outcome measure is the patient-reported Shoulder Disability Questionnaire. The secondary outcome measures include both disease-specific and generic measures, and an economic evaluation. Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses.
  
  
  CONCLUSIONS
  The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented. The results of this study will improve insight into the best moment of referral for surgery for SIS.
authors.affiliation: Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, The Netherlands. o.dorrestijn@orth.umcg.nl
authors.forename: Oscar
authors.initials: O
authors.lastname: Dorrestijn
authors.forename: Martin
authors.initials: M
authors.lastname: Stevens
authors.forename: Ron L
authors.initials: RL
authors.lastname: Diercks
authors.forename: Klaas
authors.initials: K
authors.lastname: van der Meer
authors.forename: Jan C
authors.initials: JC
authors.lastname: Winters
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001182:Arthroscopy / Q000379:methods; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D018579:Patient Selection; D012008:Recurrence; D012107:Research Design; D012720:Severity of Illness Index; D019534:Shoulder Impingement Syndrome / Q000188:drug therapy / Q000534:rehabilitation / Q000601:surgery*; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal