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Open AccessArticle

The Effectiveness of Individual or Group Physiotherapy in the Management of Sub-Acromial Impingement: A Randomised Controlled Trial and Health Economic Analysis

1
General Practice Elective Care Service (MSK), Eastern GP Federations, Belfast, BT8 7AR, Ireland
2
Rheumatology Department, South Eastern Health and Social Services Trust, Dundonald BT16 1RH, Ireland
3
School of Health Sciences, Ulster University, Belfast BT37 0QB, Ireland
4
Northern Ireland Clinical Trials Unit, Belfast BT12 6BA, Ireland
5
Department of General Practice, Queen’s University Belfast, Belfast BT7 1NN, UK
6
Department of Primary Care, Keele University, Staffordshire ST5 5BG, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(15), 5565; https://doi.org/10.3390/ijerph17155565
Received: 29 May 2020 / Revised: 10 July 2020 / Accepted: 29 July 2020 / Published: 1 August 2020
(This article belongs to the Special Issue The Challenges and Opportunities for Promoting Active Healthy Ageing)
Background: Shoulder pain is common in primary care. The management of subacromial impingement (SAI) can include corticosteroid injections and physiotherapy. Physiotherapy can be on an individual or group basis. Aim: To examine the clinical effectiveness and make an economic analysis of individual versus group physiotherapy, following corticosteroid injection for SAI. Design and Setting: A single-blind, open-label, randomised equivalence study comparing group and individual physiotherapy. Patients referred by local general practitioners and physiotherapists were considered for inclusion. Method: Patients were randomised to individual or group physiotherapy groups, and all received corticosteroid injection before physiotherapy. The primary outcome measure was shoulder pain and disability index (SPADI) at 26 weeks. An economic analysis was conducted. Results and Conclusion: 136 patients were recruited, 68 randomised to each group. Recruitment was 68% of the target 200 participants. SPADI (from baseline to 26 weeks) demonstrated a difference (SE) in mean change between groups of −0.43 (5.7) (p-value = 0.050001), and the TOST (two-one-sided test for equivalence) 90% CI for this difference was (−10.0 to 9.14). This was borderline. In a secondary analysis using inputted data, patients without SPADI at week 26 were analysed by carrying forward scores at week 12 (mean difference (95% CI) = −0.14 (−7.5 to 7.3), p-value = 0.014). There is little difference in outcome at 26 weeks. Group physiotherapy was cheaper to deliver per patient (£252 versus £84). Group physiotherapy for SAI produces similar clinical outcomes to individual physiotherapy with potential cost savings. Due to low recruitment to our study, firm conclusions are difficult and further research is required to give a definitive answer to this research question. (NCT Clinical Trial Registration Number NCT04058522). View Full-Text
Keywords: shoulder; physiotherapy; group; subacromial impingement shoulder; physiotherapy; group; subacromial impingement
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Ryans, I.; Galway, R.; Harte, A.; Verghis, R.; Agus, A.; Heron, N.; McKane, R. The Effectiveness of Individual or Group Physiotherapy in the Management of Sub-Acromial Impingement: A Randomised Controlled Trial and Health Economic Analysis. Int. J. Environ. Res. Public Health 2020, 17, 5565.

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