Physiotherapy in patients with clinical signs of shoulder impingement syndrome: a randomized controlled trial.

OBJECTIVE To investigate the effect of individualized manual physiotherapy and exercises compared with individualized exercises alone in patients with shoulder impingement syndrome. DESIGN Randomized controlled trial. SUBJECTS Patients with shoulder impingement of more than 4 weeks' duration. METHODS Patients in the intervention group were treated with individually adapted exercises and examination-based physiotherapy. Controls were treated with individually adapted exercises only. Both groups had 10 treatment sessions over a period of 5 weeks and subsequently continued their exercises at home for another 7 weeks. Results were analysed at 5 and 12 weeks after the start of the study. Primary outcome measures were: Shoulder Pain and Disability Index, and Patient's Global Impression of Change. Secondary outcome measures were: mean weekly pain score; Generic Patient-Specific Scale; and Patients' Satisfaction with Treatment. RESULTS A total of 46 patients were randomized to the intervention group and 44 to the control group. Although both groups showed significant improvements, there was no difference between groups for the primary and secondary outcomes at any time. Only the results for mean pain differed at 5 weeks in favour of the intervention group. CONCLUSION Individually adapted exercises were effective in the treatment of patients with shoulder impingement syndrome. Individualized manual physiotherapy contributed only a minor amount to the improvement in pain intensity. However, further research is necessary to confirm these results before definite recommendations can be made.