title: A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study).
abstract: OBJECTIVE
  To evaluate the clinical effectiveness of a self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy.
  
  
  METHODS
  Multi-centre pragmatic unblinded parallel group randomised controlled trial.
  
  
  METHODS
  UK National Health Service.
  
  
  METHODS
  Patients with a clinical diagnosis of rotator cuff tendinopathy.
  
  
  METHODS
  The intervention was a programme of self-managed exercise prescribed by a physiotherapist in relation to the most symptomatic shoulder movement. The control group received usual physiotherapy treatment.
  
  
  METHODS
  The primary outcome measure was the Shoulder Pain & Disability Index (SPADI) at three months. Secondary outcomes included the SPADI at six and twelve months.
  
  
  RESULTS
  A total of 86 patients (self-managed loaded exercise n=42; usual physiotherapy n=44) were randomised. Twenty-six patients were excluded from the analysis because of lack of primary outcome data at the 3 months follow-up, leaving 60 (n=27; n=33) patients for intention to treat analysis. For the primary outcome, the mean SPADI score at three months was 32.4 (SD 20.2) for the self-managed group, and 30.7 (SD 19.7) for the usual physiotherapy treatment group; mean difference adjusted for baseline score: 3.2 (95% Confidence interval -6.0 to +12.4 P = 0.49).By six and twelve months there remained no significant difference between the groups.
  
  
  CONCLUSIONS
  This study does not provide sufficient evidence of superiority of one intervention over the other in the short-, mid- or long-term and hence a self-management programme based around a single exercise appears comparable to usual physiotherapy treatment.
authors.affiliation: School of Health & Related Research, University of Sheffield, Sheffield, UK c.littlewood@sheffield.ac.uk.
authors.forename: Chris
authors.initials: C
authors.lastname: Littlewood
authors.affiliation: Derby Teaching Hospitals NHS Foundation Trust, Physiotherapy Department, London Road Community Hospital, Derby, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bateman
authors.affiliation: Solent NHS Trust, Physiotherapy Outpatient Department, St Marys Community Health Campus, Portsmouth, UK.
authors.forename: Kim
authors.initials: K
authors.lastname: Brown
authors.affiliation: Doncaster & Bassetlaw Hospitals NHS Foundation Trust, Physiotherapy Department, Doncaster Royal Infirmary, Doncaster, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Bury
authors.affiliation: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for South Yorkshire, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Sue
authors.initials: S
authors.lastname: Mawson
authors.affiliation: Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: May
authors.affiliation: School of Health & Related Research, University of Sheffield, Sheffield, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Walters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff; D012648:Self Care; D052256:Tendinopathy / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Rotator cuff tendinopathy; exercise; quality of life; rehabilitation; self-management