title: Implementation of conservative treatment prior to arthroscopic subacromial decompression of the shoulder.
abstract: OBJECTIVE
  The aim of the study was to investigate to what extent patients undergo evidence-based conservative treatment prior to arthroscopic subacromial decompression of the shoulder.
  
  
  METHODS
  One hundred and twenty patients (65 women, 55 men, median age 53.5 years (range 28-70), referred to arthroscopic subacromial decompression at two hospitals in Norway, were consecutively included in the study. The patients completed a self-administered questionnaire including questions concerning the quantity and nature of preoperative treatment as well as the QuickDASH score. They were specifically asked for the extent of evidence-based conservative treatment, i.e. the combination of strengthening and stretching exercises at a minimum weekly amount and total duration.
  
  
  RESULTS
  One hundred and nine patients (91 %) reported having received conservative treatment guided by a physiotherapist preoperatively. The patients' main reasons for not seeing a physiotherapist were lack of trust in the treatment (N = 7) and the assumption that surgery would provide faster relief of symptoms (N = 6). Of those visiting a physiotherapist, 80 % received specific shoulder exercises. Forty-five per cent did both strengthening and stretching exercises, only 32 % did the exercises three times per week more than 2 months, and 24 % did more than 3 months as recommended. Seventy-six per cent of the patients who discontinued the prescribed exercise programme did this due to increasing pain.
  
  
  CONCLUSIONS
  Most of the patients in the current study reported having visited a physiotherapist before surgery. However, less than half of them underwent evidence-based exercise treatment, and increased pain was the main reason for not completing the prescribed exercise treatment. The results might be of clinical relevance for physiotherapists treating patients with SAPS, but also for orthopaedic surgeons doing preoperative evaluations.
  
  
  METHODS
  Case series, IV.
authors.affiliation: Department of Occupational therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.
authors.forename: Ingrid Husdal
authors.initials: IH
authors.lastname: Dørum
authors.affiliation: Martina Hansens Hospital, Baerum, Norway.
authors.forename: Stig
authors.initials: S
authors.lastname: Heir
authors.affiliation: Aleris Nesttun, Bergen, Norway.|Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Eirik
authors.initials: E
authors.lastname: Solheim
authors.affiliation: Department of Occupational therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway. liv.magnussen@hib.no.|Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway. liv.magnussen@hib.no.
authors.forename: Liv Heide
authors.initials: LH
authors.lastname: Magnussen
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods; D000072700:Conservative Treatment; D019299:Decompression, Surgical / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D057234:Preoperative Period; D019534:Shoulder Impingement Syndrome / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Acromioplasty; Exercise therapy; Physiotherapy; Shoulder arthroscopy; Subacromial decompression; Subacromial pain syndrome