Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial

Abstract

Question: What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain? Design: Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis. Participants: A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region. Interventions: Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks. Outcome measures: The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant’s perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers. Results: There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE −2 (95% CI −9 to 5), GE minus HE −2 (95% CI −9 to 5) and HE minus IE 1 (95% CI −6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens’ effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups. Conclusion: In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs. Trial registration: ClinicalTrials.gov: NCT03055117

Keywords

• Shoulder pain
• Rehabilitation
• Physical therapy
• Subacromial pain
• Shoulder impingement
• Exercise therapy