OBJECTIVE: To evaluate whether psychomotor therapy (PMT) in combination with usual care active exercise (AE) rehabilitation for the shoulder is superior to merely AE.
DESIGN: The trial was a single-center, stratified (by corticosteroid injection [yes or no]), randomized, and controlled superiority trial.
SETTING: Shoulder unit of the orthopedic department at Hospital Lillebaelt, Vejle Hospital.
PARTICIPANTS: Eligible participants (N=87) were adults aged 18-75 years with shoulder complaints lasting for at least 3 months, in addition to a score equal to or below 3 on the Multidimensional Assessment of Interoceptive Awareness score. Furthermore, patients had at least a visual analog scale pain score of 2 at rest, 3 at night, and 5 in activity (range: 0-10).
INTERVENTIONS: Patients were randomized to 12 weeks of AE (control group) or in combination with 5 PMT sessions (intervention group).
MAIN OUTCOME MEASURE: The primary outcome was the patient-reported outcome score Disability of the Arm, Shoulder and Hand questionnaire. The primary endpoint was 12 weeks after baseline.
RESULTS: There was no between-group difference in function between the intervention group and control group.
CONCLUSIONS: Our results showed no additional benefit on patient-reported function and pain from PMT over usual care in patients with long-lasting shoulder pain and low body awareness. This finding suggests that PMT adds no additional benefit to patients' recovery in relation to pain and active function in comparison to standard care.
|Rehab Clinician (OT/PT)|
Not many studies are available on this shoulder topic. It indicates that an active exercise program still is very important. The PMTpart could have different results in a different study group, however this should be investigated further.
Not knowing what psychomotor therapy was, I did learn something. It's also clear that it wasn’t useful. Perhaps doing rehab of any sort will help those with chronic shoulder pain.
Ingrwersen's et al. (2019) RCT is a single-center, randomized and controlled superiority trial applied to Chronic Shoulder Pain patients and designed to evaluate whether adding breathing and body awareness exercises to usual care active exercise rehabilitation is beneficial to DASH score and pain intensity (NRS). Applying PEDro scale to measure the quality of the report, I got 8/10, which means the RCT has a reasonable bias control. Ingrwersen's et al. (2019) is probably the first well-designed RCT trying to verify the effectiveness of a strategy to increase knowledge of patient's body, such as signals from sensory and kinesthetic system, and increase self-efficacy in relation to different symptoms. Results showed that adding five sessions of the tested protocol did not add benefit to patient-reported function and pain over usual care with active exercises.
This is a great article for those who currently are using or thinking of using a biopsychosocial approach, combining pedagogic and manual therapeutic approaches, with aspects of self-awareness and self-efficacy education. This study does not show benefit using this approach in combination with an active exercise program in a cohort of shoulder pain subjects.