The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial
The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial
复制标题
DOI：
10.1093/milmed/usy294
复制
发表时间：
2019-05-01
影响因子：
1.2
通讯作者：
Hebert, Luc J.
中科院分区：
文献类型：
--
作者：
Ager, Amanda L.;Roy, Jean-Sebastien;Hebert, Luc J.
简介：肩痛是咨询医生或理疗师的主要原因，但它仍然是康复的一个挑战，特别是对于军人来说。肩袖 (RC) 肌腱病是肩部疼痛的最重要原因，也是病假或退伍的主要原因之一。研究鼓励使用运动处方来治疗 RC 肌腱病，但理想的治疗方法（小组设置还是一对一）仍然不确定。这项单盲（评估者）试点随机临床试验的目的是比较两个为期 6 周的康复计划、新开发的团体监督神经肌肉训练计划和通常的一对一物理治疗护理，对受 RC 肌腱病影响的加拿大士兵的疼痛和症状。材料和方法：31 名加拿大武装部队士兵被随机分配到 (1) 团体监督神经肌肉训练计划 (UPEx-NTP) 或； (2) 一对一的常规理疗护理(UPC)。主要结果是手臂、手和肩部残疾（DASH）问卷。次要结果包括西安大略肩袖 (WORC) 指数、休息时的疼痛程度以及受影响肩部的外展肌和外旋肌的最大等长自主收缩 (MIVC)。两者均在基线 (T-0)、6 (T-6) 和 12 (T-12) 周时进行评估。分析包括意向治疗 (ITT) 和符合方案分析的双向重复方差测量。结果：我们联系了 80 名患有 RC 肌腱病的军人，其中 31 名参与者被随机分配，分别在 UPEx-NTP 或 UPC 中进行积极干预。 ITT 或符合方案分析均未发现显着的组 (p >= 0.16) 或组 x 时间交互作用 (p >= 0.11)。 DASH 和 WORC 具有统计学上显着的时间效应 (p < 0.001)，表明两组随着时间的推移都有所改善。结论：我们的初步数据表明，两种以主动锻炼为基础的康复方法在统计上没有差异，并且随着时间的推移，为军人带来了类似的好处。这表明针对 RC 肌腱病的团体干预有可能与针对军人的一对一方法一样有效，这对于活跃的工作人群来说是一种有趣的途径。关于监督小组方法的成本和临床资源效益，需要更大的样本量和进一步的研究。
Introduction: Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. Materials and Methods: Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T-0), 6 (T-6) and 12 (T-12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. Results: Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p >= 0.16) or group x time interactions (p >= 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. Conclusions: Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.