title: Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.
abstract: BACKGROUND
  Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery.
  
  
  METHODS
  A multicenter randomized controlled trial was conducted.
  
  
  METHODS
  The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region.
  
  
  METHODS
  One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated.
  
  
  METHODS
  A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used.
  
  
  METHODS
  The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire.
  
  
  RESULTS
  At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures.
  
  
  CONCLUSIONS
  The nature of the exercise intervention did not allow blinding of patients and care providers.
  
  
  CONCLUSIONS
  The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care.
authors.affiliation: D.H. Christiansen, PT, PhD, Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic, Gl Landevej 61, 7400 Herning, Denmark. David.Christiansen@vest.rm.dk.
authors.forename: David Høyrup
authors.initials: DH
authors.lastname: Christiansen
authors.affiliation: P. Frost, MD, PhD, Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus Hospital, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Poul
authors.initials: P
authors.lastname: Frost
authors.affiliation: D. Falla, PT, PhD, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom, and Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
authors.forename: Deborah
authors.initials: D
authors.lastname: Falla
authors.affiliation: J.P. Haahr, MD, MPH, Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic.
authors.forename: Jens Peder
authors.initials: JP
authors.lastname: Haahr
authors.affiliation: L.H. Frich, MD, PhD, Orthopedic Department, Odense University Hospital, Odense, Denmark.
authors.forename: Lars Henrik
authors.initials: LH
authors.lastname: Frich
authors.affiliation: L.C. Andrea, MD, Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic.
authors.forename: Linda Christie
authors.initials: LC
authors.lastname: Andrea
authors.affiliation: S.W. Svendsen, MD, PhD, Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland-University Research Clinic.
authors.forename: Susanne Wulff
authors.initials: SW
authors.lastname: Svendsen
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000534:rehabilitation*; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012782:Shoulder / Q000503:physiopathology*; D019534:Shoulder Impingement Syndrome / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D012785:Shoulder Joint / Q000503:physiopathology*; D020069:Shoulder Pain / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery