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The Effect of Scapular Proprioceptive Neuromuscular Facilitation Techniques on Pain and Functionality in Subacromial Impingement Syndrome

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ClinicalTrials.gov Identifier: NCT04273568
Recruitment Status : Completed
First Posted : February 18, 2020
Last Update Posted : February 18, 2020
Sponsor:
Information provided by (Responsible Party):
Tuğba Akgüller, Istanbul Arel University

Brief Summary:
The aim of this study was to investigate the effects of scapular proprioceptive neuromuscular facilitation (PNF) techniques applied in addition to exercise therapy in patients with Subacromial impingement syndrome (SIS) on pain, pressure pain threshold (PPT), range of motion (ROM), functionality, scapular dyskinesis, active trigger points and emotional state.

Condition or disease Intervention/treatment Phase
Shoulder Impingement Syndrome Other: Scapular PNF Other: Exercise program Not Applicable

Detailed Description:

32 patients between the ages of 20-60 diagnosed with SIS were included in the study.

The patients were randomly divided into two groups. The exercise group received an exercise program of 12 sessions. Scapular PNF techniques were applied to the PNF group with the same exercise program. Patients were evaluated twice; one before and one after 6 weeks of treatment; using Visual Analogue Scale (VAS) for pain, algometer for PPT, digital goniometer for range of motion (ROM), The Disabilities of Arm, Shoulder and Hand (DASH) for functional status, lateral scapular slide test (LSST) for scapular dyskinesis, Travell and Simons criteria for trigger point and Hospital Anxiety and Depression Scale (HADS) for emotional state. At the end of treatment patient satisfaction was evaluated with Global Change Scale.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 32 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: The Effect of Scapular Proprioceptive Neuromuscular Facilitation Techniques on Pain and Functionality in Subacromial Impingement Syndrome
Actual Study Start Date : March 1, 2019
Actual Primary Completion Date : August 30, 2019
Actual Study Completion Date : August 30, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Group1 (PNF group)
Scapular PNF and exercise program was applied to the PNF group.
Other: Scapular PNF
Rhythmic initiation and repetitive stretching techniques in scapula anterior elevation-posterior depression and anterior depression-posterior elevation patterns were applied twice a week for 6 weeks.

Other: Exercise program
An exercise program consisting of exercises used in the conservative treatment of shoulder impingement syndrome for both groups was applied twice a week for 6 weeks.

Active Comparator: Group 2 (Exercise group)
Exercise program was applied to the exercise group
Other: Exercise program
An exercise program consisting of exercises used in the conservative treatment of shoulder impingement syndrome for both groups was applied twice a week for 6 weeks.




Primary Outcome Measures :
  1. Change from Baseline Pain intensity of the patients at 6 weeks [ Time Frame: Baseline and 6 weeks ]
    Pain intensity of the patients at rest, during activity and at night was assessed using the VAS; Visual Analog Scale. In this evaluation, individuals were told that the number "0" on the 10 cm long horizontal line expresses "no pain", and the number "10" indicates "unbearable pain" and that individuals should mark their intensity of pain on this line.

  2. Change from Baseline Functional Status of the patients at 6 weeks [ Time Frame: Baseline and 6 weeks ]
    The functional status of the patients were evaluated by The Disabilities of the Arm, Shoulder and Hand (DASH). DASH is a scale consisting of 30 questions that question the functional status and symptoms used in musculoskeletal disorders of the upper extremity.The number of Likert scale (1: no difficulty, 5: I can not do at all) is used in answering the questions and the total score obtained is between 0 and 100.


Secondary Outcome Measures :
  1. Shoulder Range of Motion (ROM) [ Time Frame: Baseline and 6 weeks ]
    EHA evaluations of flexion, abduction, internal rotation and external rotation of the shoulder joint were performed in the supine position using the digital goniometer.

  2. Pain Pressure Threshold (PPT) [ Time Frame: Baseline and 6 weeks ]
    Pressure pain threshold was evaluated using the Algometer (dolorimeter).

  3. Scapular dyskinesis [ Time Frame: Baseline and 6 weeks ]
    Scapular Dyskinesis was evaluated with "The Lateral Scapular Slide Test (LSKT)". In this test, the distance of the inferior angle of the scapula to the nearest spinous process at 3 different positions (0°, 40-45°, 90°) is measured, and a difference of 1 cm or more between the two sides in any of the three positions is considered positive for scapular dyskinesis.

  4. Active trigger points [ Time Frame: Baseline and 6 weeks ]
    Active trigger points were evaluated by palpation method according to Travell and Simons criteria. Scalene, upper trapezius, levator scapula, supraspinatus, infraspinatus, subskapularis, teres minor, teres major, deltoid anterior, middle and posterior group fibers, pectoralis major, pectoralis minor, biceps brachii muscles were evaluated with palpation method in terms of trigger point presence.

  5. Emotional state [ Time Frame: Baseline and 6 weeks ]
    The emotional states of the cases were evaluated using the Hospital Anxiety and Depression Scale (HAD), which consists of 14 questions. (HAD). This scale has a 7-question anxiety (HAD-A) subscale that evaluates the anxiety state, and a 7-question depression (HAD-D) subscale that evaluates the state of depression, and a four-point likert scale is used to answer the questions. For the total score of each sub-score, 0-7 points are normal, 8-10 points are at the border, and 11 points are defined as abnormal


Other Outcome Measures:
  1. Patient Satisfaction: Global Rating of Change (GRC) scale [ Time Frame: At the end of the 6-weeks treatment ]
    Patient Satisfaction was assessed Global Rating of Change (GRC) scale. The scale used included 5 points (-2: I am much worse. -1: I am worse, 0: I am the same, +1: I am better, +2: I am much better).



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Ages Eligible for Study:   20 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Aged between 20 and 60
  • Diagnosed with SIS by MRI and clinical examination and a specialist physician
  • Positive impingement tests (Hawkings, Neer and Jobe test) or painful motion arc (60 ° -120 °)
  • Unilateral shoulder pain that has been going on for at least 3 months
  • Signed voluntary consent form

Exclusion Criteria:

  • Diagnosed with adhesive capsulitis or massive rotator cuff tear
  • Having undergone upper limb surgery
  • Presence of rheumatological systemic diseases
  • Presence of Glenohumeral instability
  • Having a neurological disease affecting the upper extremity
  • Diagnosed with cervical radiculopathy
  • Degenerative joint disorders
  • Having communication problems
  • Steroid injection therapy or physiotherapy in the past 6 months have been rehabilitated

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04273568


Locations
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Turkey
Istanbul Aydin University
Istanbul, Turkey, 34295
Sponsors and Collaborators
Tuğba Akgüller
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Responsible Party: Tuğba Akgüller, Lecturer, Istanbul Arel University
ClinicalTrials.gov Identifier: NCT04273568    
Other Study ID Numbers: tugbaakguller
First Posted: February 18, 2020    Key Record Dates
Last Update Posted: February 18, 2020
Last Verified: February 2020

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Tuğba Akgüller, Istanbul Arel University:
Proprioceptive Neuromuscular Facilitation
Shoulder pain
Additional relevant MeSH terms:
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Shoulder Impingement Syndrome
Syndrome
Rotator Cuff Injuries
Disease
Pathologic Processes
Rupture
Wounds and Injuries
Shoulder Injuries
Tendon Injuries
Joint Diseases
Musculoskeletal Diseases