Santello G, Rossi DM, Martins J, et al. Effects on shoulder pain and disability of teaching patients with shoulder pain a home-based exercise program: a randomized controlled trial. Clin Rehabil. 2020 Jun 7:269215520930790. doi: 10.1177/0269215520930790. (Original study)

OBJECTIVE: To investigate the effect on shoulder pain and disability of teaching patients with shoulder pain how to undertake a home-based exercise program.

DESIGN: A randomized controlled trial conducted from September 2015 to January 2016.

SETTING: Participants' home.

PARTICIPANTS: Sixty participants with shoulder pain who were waiting for physiotherapeutic treatment.

INTERVENTIONS: The control group (n = 30) received minimal education about their shoulder condition and instructions to continue their activities as normal. The intervention group (n = 30) received a two-month home exercise program with one-hour sessions delivered by a physiotherapist to begin and one month after the program for exercise instructions.

MAIN MEASURES: The primary outcome was change in the Shoulder Pain and Disability Index (SPADI). The secondary outcomes included change in the numeric pain rating scale and medication intake for pain relief.

RESULTS: The patients' average age was 54.3 (13.8) years. SPADI scores at baseline were 60.9 (16.5) in the intervention and 64.7 (15.3) in the control group. After two months, the SPADI scores decreased to 18.8 (28.6) and to 61.4 (24.0), respectively, in the intervention and control groups with an estimated mean difference of 40.0, effect size: 1.61. The intervention group showed a reduced pain intensity (estimated mean difference: 3.7, effect size: 2.43) and medication intake (chi-square: 0.001). The number needed to treat was 1.2 for one patient to have a SPADI score <20.

CONCLUSION: Teaching patients with shoulder pain how to undertake a home-based exercise program improved shoulder function and reduced pain intensity and medication intake over two months.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
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Comments from MORE raters

Rehab Clinician (OT/PT) rater

The results of the study highlights the importance of psychosocial components in the treatment in addition to the exercise therapy in chronic conditions. The study results were very positive in the short-term but the longer term result is unknown.

Rehab Clinician (OT/PT) rater

This is an interesting article in which the authors investigate the added value of a home-based exercise program in patients with shoulder pain. They compared it with a control treatment only prescribing advice. The results of this treatment are promising, but there may also be a risk of bias in this study. This might, for example, be the case in the combination of the diagnosis ("a primary diagnosis of rotator cuff tendinopathy"), treatment, and the outcome measurement. It seems a bit illogical, for example, that in this group of patients, no change in shoulder ROM and hardly any change in the PROMS took place.

Rehab Clinician (OT/PT) rater

Whilst acknowledging the issues in the research (e.g. small sample size, imbalance of control v active groups), the findings have relevance in helping clinicians in prescribing a home exercise shoulder programme.
Comments from PAIN+ CPN subscribers

Mr. Ashok Jain (6/18/2020 12:38 PM)

Would any therapist provide a therapy intervention at the clinic without a home-based exercise program ? Would any therapist provide any home-based exercise program with giving proper instructions including strategies to manage pain at home? Really!!! So, it appears that, in this study, the control group did not receive any instructions. How did it pass the research ethics committee?