Clinical Research Directory

Personalised Education Versus Usual Physiotherapy for Acute Rotator Cuff-Related Shoulder Pain

Rotator cuff-related shoulder pain (RCRSP) is one of the most common musculoskeletal disorders presenting in primary care. It is frequently associated with persistent pain, disability, healthcare utilisation and work absenteeism. Exercise-based physiotherapy is recommended as first-line management in clinical practice guidelines, yet its average effects on pain and disability are modest and a substantial proportion of people remain symptomatic several months after onset. Patient education is also recommended, and trials conducted in people with persistent symptoms suggest that education-based care may produce improvements comparable to those obtained with progressive exercise. However, the effectiveness of a structured educational intervention as a first-line management strategy during the acute phase of RCRSP remains unclear. SHOULD Education lead Rehabilitation? (SHOULD-ER) is a multicentre, pragmatic, parallel-group, non-inferiority randomised controlled trial comparing a personalised, multimodal educational intervention with usual physiotherapy care in adults presenting with acute non-traumatic RCRSP of less than six weeks duration. Participants will be randomly assigned to one of the trial arms for a 12-week treatment period, with follow-up to 24 weeks. The primary objective is to determine whether the educational intervention is non-inferior to usual physiotherapy care regarding improvement in shoulder pain and disability at 12 weeks, measured by the Shoulder Pain and Disability Index (SPADI). Secondary outcomes include pain-related function, self-efficacy, fear-avoidance beliefs, quality of life, sleep quality, patient satisfaction and healthcare costs. A nested qualitative study and a within-trial economic evaluation are embedded in the trial. An exploratory analysis of prognostic factors will also be conducted with a secondary analysis.

Effects of Knowledge of Results Intervention in Rotator Cuff-Related Shoulder Pain

Previous research demonstrates that augmented feedback effectively enhances motor skills and performance in both healthy individuals and those with neurological conditions. However, while the role of Knowledge of Results (KR)-a specific augmented feedback strategy-in supporting motor learning is well-established, its efficacy in improving rehabilitation outcomes remains unclear. Notably, there is a lack of studies in the current literature investigating the effects of augmented feedback strategies in individuals with rotator cuff-related shoulder pain (RCRSP). Given the complex and multidimensional pain neurophysiology associated with RCRSP, a KR intervention is hypothesized to hold significant potential for restoring motor control, correcting pain-driven maladaptive movement patterns, alleviating pain, and recovering function in this population. Therefore, the primary objective of this study is to investigate the effects of a KR intervention on clinical outcomes, physical performance, and psychosocial parameters in individuals with RCRSP. The study is designed as a two-arm, prospective, parallel-group, randomized controlled trial. Eligible participants meeting the inclusion criteria will be randomly allocated to either the intervention (n = 28; standard rehabilitation program+ KR intervention)or control group (n = 28; standard rehabilitation program) using computer-based randomization software (www.sealedenvelope.com). Both groups will undergo the same routine exercise-based treatment protocol over an 8-week period, consisting of one physiotherapist-supervised session per week and a home exercise program on the remaining days. While the control group will solely receive the standard rehabilitation program, the intervention group will additionally receive the KR intervention, wherein their assessment results will be regularly shared throughout the treatment process. Conversely, these data will only be disclosed to the control group participants at the conclusion of the 8-week intervention.

Could a Feedback Device Help Manage Work-related Shoulder Disorders?

Work-related shoulder pain is a common problem with significant socio-economic repercussions. The impact of these disorders on workers is considerable, particularly in terms of pain, disability and reduced quality of life. Several occupational factors may explain the onset of these disorders, such as changes in the work environment, physical demands, psychosocial factors specific to the occupational context and the age of workers. The lack of quantitative measurement tools to assess the physical demands of work over an extended period of time is sorely felt. Recently, our team developed a wearable feedback device, similar to a watch worn on the arm, which measures shoulder movements and muscle activity, transforming this real-time data into clinical indicators. These indicators provide immediate feedback to workers, enabling them to better understand the physical demands of their tasks and adapt accordingly. If this device proves effective in reducing physical demands, it could become a valuable tool for guiding workplace assessments and interventions. However, this device has not yet been tested on workers with shoulder pain. For this reason, a two-part pilot study is needed to understand user needs, assess ease of use and the feasibility of implementing the device. The first component will consist of a pilot clinical trial involving 42 workers suffering from shoulder pain, divided into two groups: one group will use the feedback device for 2 weeks, while the other group will continue to work without intervention. The second phase will analyze the experience of participants who have used the device.