Supervised Exercises May Be Better Than Shockwave Treatment for Chronic Shoulder Pain
By Laurie Barclay, MD
Medscape Medical News
September 18, 2009 — Supervised exercises are more effective than shockwave treatment to relieve chronic shoulder pain, according to the results of a single-blind randomized study published online September 15 in BMJ.
"Shockwave treatment is increasingly used for subacromial shoulder pain," write Kaia Engebretsen, a physiotherapist from Ullevaal University Hospital in Oslo, Norway, and colleagues. "To our knowledge, radial extracorporeal shockwave treatment has not been compared with exercises in a clinical trial, [particularly in] patients with shoulder pain. The purpose of this study was to compare the short-term effects of radial extracorporeal shockwave treatment and supervised exercises in patients with subacromial shoulder pain."
At an outpatient clinic of physical medicine and the rehabilitation department at Ullevaal University Hospital, 104 patients with subacromial shoulder pain lasting 3 months or more were randomized to receive radial extracorporeal shockwave treatment (1 session weekly for 4 to 6 weeks) or supervised exercises (two 45-minute sessions weekly for up to 12 weeks).
Age, education, dominant arm affected, and pain duration were similar in both groups at study initiation. The shoulder pain and disability index was the main study end point.
The investigators found a treatment effect favoring supervised exercises at 6, 12, and 18 weeks, with an adjusted treatment effect of ?8.4 points (95% confidence interval [CI], ?16.5 to ?0.6). Compared with the shockwave-treatment group, the group treated with supervised exercises had a significantly higher proportion of patients who improved in terms of shoulder pain and disability scores (64% vs 36%; odds ratio [OR], 3.2; 95% CI, 1.3 to 7.8).
Additional treatment between 12 and 18 weeks was needed in more patients in the shockwave-treatment group than in the exercise group (OR, 5.5; 95% CI, 1.3 to 26.4), and fewer patients returned to work.
"Supervised exercises were more effective than radial extracorporeal shockwave treatment for short-term improvement in patients with subacromial shoulder pain," the study authors write.
Limitations of this study include the lack of a placebo group, the lack of injection of local anesthetics into the subacromial space to improve diagnostic accuracy, and the possibly insufficient power to detect differences in the secondary outcome variables.
"After 18 weeks, supervised exercises were better than radial extracorporeal shockwave treatment in terms of the primary outcome variable — the shoulder pain and disability index — and 1 secondary outcome variable — work status," the study authors conclude. "We found no significant differences for the other secondary outcome variables of pain, function, active range of motion, and use of drug treatment. More patients in the supervised-exercise group improved, probably owing to a treatment effect."
Health Region East, Norway, supported this study. The study authors have disclosed no relevant financial relationships.
