Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial

TY - JOUR

T1 - Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain

T2 - a randomised trial

AU - Christiansen, David Høyrup

AU - Hjort, Jakob

N1 - Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

PY - 2021/4

Y1 - 2021/4

N2 - QUESTION: What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain?DESIGN: Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis.PARTICIPANTS: A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region.INTERVENTIONS: Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks.OUTCOME MEASURES: The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers.RESULTS: There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups.CONCLUSION: In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs.TRIAL REGISTRATION: ClinicalTrials.gov: NCT03055117.

AB - QUESTION: What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain?DESIGN: Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis.PARTICIPANTS: A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region.INTERVENTIONS: Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks.OUTCOME MEASURES: The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers.RESULTS: There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups.CONCLUSION: In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs.TRIAL REGISTRATION: ClinicalTrials.gov: NCT03055117.

KW - Exercise therapy

KW - Physical therapy

KW - Rehabilitation

KW - Shoulder impingement

KW - Shoulder pain

KW - Subacromial pain

U2 - 10.1016/j.jphys.2021.02.015

DO - 10.1016/j.jphys.2021.02.015

M3 - Journal article

C2 - 33744191

SN - 1836-9553

VL - 67

SP - 124

EP - 131

JO - Journal of Physiotherapy

JF - Journal of Physiotherapy

IS - 2

ER -