title: Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: a single-blind randomized controlled clinical trial.
abstract: BACKGROUND
  Traditional rehabilitation improves pain and function in patients with shoulder impingement syndrome. Neurocognitive rehabilitation has shown to be highly effective after surgical reconstruction of the anterior cruciate ligament. However, its effects in patients with shoulder impingement syndrome have not yet been established.
  
  
  OBJECTIVE
  The aim of the study was to compare the effects of neurocognitive therapeutic exercise, based on proprioception and neuromuscular control, on pain and function in comparison to traditional therapeutic exercise in patients with shoulder impingement syndrome.
  
  
  METHODS
  Single-blind randomized, non-inferiority clinical trial.
  
  
  METHODS
  Outpatient clinic of Geriatrics and Physiatrics, University Hospital.
  
  
  METHODS
  Forty-eight patients with shoulder impingement syndrome (Neer stage I) and pain lasting for at least three months.
  
  
  METHODS
  Participants were randomly allocated (1:1) to either neurocognitive therapeutic exercise or traditional therapeutic exercise. Both treatments were provided one-hour session, three times a week for five weeks. The primary outcome measure was the short form of the Disability of the Arm, Shoulder and Hand Questionnaire (Quick-DASH questionnaire) for the assessment of physical ability and symptoms of the upper extremity.
  
  
  METHODS
  Constant-Murley shoulder outcome score for the determination of range of motion, pain and strength; American Shoulder and Elbow Surgeons Society standardized shoulder assessment form for the evaluation of physical ability in daily-living tasks; a visual analogue scale for pain assessment at rest and during movements; Likert score for the estimation of participant satisfaction.
  
  
  METHODS
  before treatment, end of treatment, 12 and 24 weeks after the completion of each intervention for all outcome measures, except for the Likert score that was evaluated only at the end of treatment.
  
  
  RESULTS
  24 weeks.
  
  
  RESULTS
  At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcomes measures relative to baseline values, except for the visual analogue scale at rest that was unaffected by traditional therapeutic exercise. For all outcome measures, changes over time were greater in the neurocognitive therapeutic exercise group relative to the traditional therapeutic exercise group. The level of satisfaction with treatment was higher for participants in the neurocognitive therapeutic exercise group.
  
  
  CONCLUSIONS
  Neurocognitive rehabilitation is effective in reducing pain and improving function in patients with shoulder impingement syndrome, with benefits maintained for at least 24 weeks.
  
  
  CONCLUSIONS
  skills and function of the shoulder can greatly benefit from neurocognitive rehabilitation.
authors.affiliation: Department of Geriatrics, Neurosciences and Orthopedics Division of Physical Medicine and Rehabilitation Teaching Hospital "Agostino Gemelli" Sacro Cuore Catholic University, Rome, Italy - emarzetti@live.com.
authors.forename: E
authors.initials: E
authors.lastname: Marzetti
authors.forename: A
authors.initials: A
authors.lastname: Rabini
authors.forename: G
authors.initials: G
authors.lastname: Piccinini
authors.forename: D B
authors.initials: DB
authors.lastname: Piazzini
authors.forename: M C
authors.initials: MC
authors.lastname: Vulpiani
authors.forename: M
authors.initials: M
authors.lastname: Vetrano
authors.forename: A
authors.initials: A
authors.lastname: Specchia
authors.forename: G
authors.initials: G
authors.lastname: Ferriero
authors.forename: C
authors.initials: C
authors.lastname: Bertolini
authors.forename: V M
authors.initials: VM
authors.lastname: Saraceni
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D019534:Shoulder Impingement Syndrome / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D016037:Single-Blind Method; D016896:Treatment Outcome