title: Effectiveness of physiotherapy and costs in patients with clinical signs of shoulder impingement syndrome: One-year follow-up of a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effect of manual physiotherapy and exercises compared with exercises alone in patients with shoulder impingement syndrome one year after inclusion.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Patients with shoulder impingement of more than 4 weeks.
  
  
  METHODS
  The intervention group received individualized manual physiotherapy plus individualized exercises; the control group received individualized exercises only. Both groups had 10 treatments over 5 weeks; afterwards all patients continued their exercises for another 7 weeks at home. Primary outcomes were the Shoulder Pain and Disability Index and Patients' Global Impression of Change. The Generic Patient-Specific Scale was used as secondary outcome. Costs were recorded in a log-book.
  
  
  RESULTS
  Ninety patients were included in the study and 87 could be analyzed at 1-year follow-up. Both groups showed significant improvements in all outcome measures, but no difference was detected between the groups. Only costs differed significantly in favour of the control group (p = 0.03) after 5 weeks.
  
  
  CONCLUSIONS
  Individualized exercises resulted in lower costs than manual physiotherapy and showed a significant effect on pain and functioning within the whole group after one year. Exercises should therefore be considered as a basic treatment. Due to the progressive improvement that occurred during the follow-up period with individualized exercises further treatments should be delayed for 3 to 4 months.
authors.affiliation: School of Therapeutic Sciences, Department of Physiotherapy, SRH University Heidelberg, Heidelberg, The Netherlands. Thilo.Kromer@EPID.unimaas.nl, tok@ptz-physio.de, thilo.kromer@maastrichtuniversity.nl, ThiloOliver.Kromer@hochschule-heidelberg.de.
authors.forename: Thilo O
authors.initials: TO
authors.lastname: Kromer
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
authors.forename: Caroline H G
authors.initials: CH
authors.lastname: Bastiaenen
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D006233:Persons with Disabilities / Q000534:rehabilitation; D005081:Exercise Therapy / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000191:economics*; D019534:Shoulder Impingement Syndrome / Q000534:rehabilitation*; D018582:Sick Leave / Q000191:economics; D016896:Treatment Outcome