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Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement

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ClinicalTrials.gov Identifier: NCT02670174
Recruitment Status : Completed
First Posted : February 1, 2016
Last Update Posted : October 11, 2019
Sponsor:
Information provided by (Responsible Party):
Patrick Van Gelder, University Ghent

Brief Summary:
A randomized controlled trial will be conducted to examine the effectiveness of a traditional home exercise program versus 2 kinetic chain home exercise programs on treatment outcome of overhead athletes with shoulder impingement syndrome. Primary outcome measures are reduction of pain and disability, and improvement in functionality and sports performance. Secondary outcome measures are strength, mobility, flexibility and functional performance.

Condition or disease Intervention/treatment Phase
Shoulder Impingement Syndrome Other: Traditional training Other: Separate kinetic chain training Other: Integrated kinetic chain training Not Applicable

Detailed Description:

Participant are randomly assigned in 3 home exercise groups.

  1. The traditional program: consists of solely strengthening the rotator cuff muscles and scapular muscles (e.g. external rotation)
  2. Separate kinetic chain program: same exercises as the first group but they also receive an exercise program to separately train the core and lower body. (e.g. external rotation separately and squat separately)
  3. Integrated kinetic chain program: same exercises as the first group but all exercises are performed while simultaneously activating the kinetic chain. (e.g. external rotation while squatting).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 38 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Subjects are randomly assigned in 3 parallel intervention groups. They cannot participate in 2 or more intervention groups.
Masking: Single (Investigator)
Primary Purpose: Treatment
Official Title: Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Shoulder Impingement Syndrome
Study Start Date : September 2015
Actual Primary Completion Date : June 2018
Actual Study Completion Date : June 2018

Arm Intervention/treatment
Active Comparator: Traditional training
A home exercise program consisting of rotator cuff and scapular muscle training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.
Other: Traditional training
Experimental: Separate kinetic chain training
A home exercise program consisting of traditional training exercises as well as separate exercises focusing on core and lower limb training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.
Other: Separate kinetic chain training
Experimental: Integrated kinetic chain training
A home exercise program consisting of traditional training exercises while integrating core and lower limb training will be performed during 6 weeks (4 sessions/week). To monitor progress and control load progression, a physical therapist will visit the subject every week.
Other: Integrated kinetic chain training



Primary Outcome Measures :
  1. Changes in Shoulder Pain And Disability Index (SPADI) score [ Time Frame: At baseline and within one week after the 6-weeks training program ]
    Patients will fill in the SPADI questionnaire to evaluate shoulder pain and function. The SPADI is a valid, reliable and frequently used questionnaire for shoulder pain patients consisting of 13 items divided in 2 subscales: pain (5 items) and disability (8 items). Each item was scored on a 10-point numeric rating scale. Total and subscale scores were summed and transformed to a score out of 100 (%) were a higher score indicates a higher level of pain and/or disability

  2. Changes in Western Ontario Shoulder Stability index (WOSI) score [ Time Frame: At baseline and within one week after the 6-weeks training program ]
    The WOSI is a patient-evaluated disease-specific quality of life scoring questionnaire that has been developed for shoulder instability patients. This 21-item questionnaire consists of 4 subscales: physical symptoms (10 items), sport/recreation/work (4 items), lifestyle (4 items), and emotions (3 items). Each item was scored on a 100-mm visual analogue scale. Total and subscale scores were summed and transformed to a score out of 100 (%) where a higher score indicates more limitations in shoulder related quality of life

  3. Subjective perception of shoulder improvement [ Time Frame: 6-weeks training program ]

    A Global Rating of Change (GROC) scale was used to quantify patient-perceived improvement of overall shoulder function after 6 weeks treatment as "improved", "unchanged" or "worse". In case they improved or got worse, the amount of change was reflected on a 5-point scale: very little change, little change, some change, a large change, a very large change. An "unchanged" condition scored 0, "improved" between 1 and 5, and "worse" between -1 and -5 points.

    amount of change was scored on a 5-point scale (very little change, little change, some change, a large change, a very large change)



Secondary Outcome Measures :
  1. Changes in shoulder muscle isokinetic strength (Biodex system 4) [ Time Frame: at baseline and within one week after the 6-weeks training program ]
    Isokinetic strength of shoulder internal and external rotators will be measured bilateral with the Biodex device (Biodex system 4, Biodex Medical Systems, Inc., Shirley, New York, USA). For further analysis, concentric peak torque (PT) (rotation) or peak force (PF) (protraction-retraction) values were normalized to body weight (BW). A higher value represents more strength and thus a better outcome.

  2. Changes in shoulder scapular isokinetic strength [ Time Frame: at baseline and within one week after the 6-weeks training program ]
    Isokinetic strength of scapular protraction and retraction muscles will be measured bilateral with the Biodex device (Biodex system 4, Biodex Medical Systems, Inc., Shirley, New York, USA). For further analysis, concentric peak torque (PT) (rotation) or peak force (PF) (protraction-retraction) values were normalized to body weight (BW). A higher value represents more strength and thus a better outcome.

  3. Changes in scapular dyskinesis [ Time Frame: at baseline and within one week after the 6-weeks training program ]
    Scapular dyskinesis will be measured by observing the scapular movement during active elevation. For both sides (left and right), scapular dyskinesis was evaluated as being present or not. In case dyskinesis was present, the amount of dyskinesis is scored as subtle or prominent.

  4. Changes in functional tests for the upper limb measured with the Y Balance Test [ Time Frame: at baseline and within one week after the 6-weeks training program ]
    The YBT-UQ is a commonly used upper extremity functional test to assess closed kinetic chain function of the stance arm while performing an open kinetic chain movement in the reaching arm. Under standardized verbal encouragement, patients stand in a three point plank position while using the free arm to push a reach indicator box as far as possible in 3 reach directions i.e. medial, inferolateral and superolateral.The average of the 3 test trials for each limb and each direction was normalized for upper limb length. Additionally, a normalized composite score per side was calculated by averaging the mean normalized test scores in the 3 reach directions. A higher scores indicates a better outcome.

  5. Return To Play (RTP) [ Time Frame: up to one week after the 6-weeks training program ]
    Is it possible to return to play after 6 weeks intervention or not? In addition, following question was asked: on a scale of 0 to 100%, what is the extent to which the injured shoulder has reached the shoulder function before the injury occurred?

  6. Changes in functional tests for the upper limb measured with the Seated Medicine Ball Throw [ Time Frame: at baseline and within one week after the 6-weeks training program ]
    The SMBT is an open kinetic chain functional screening test to assess bilateral upper body power and strength. The subjects were instructed to sit on the floor with the head, shoulder and back against the wall while holding a 2kg medicine ball with both arms.Participants had to throw the medicine ball forward, in a straight line and as far as possible with head, shoulders and back maintaining full wall contact. For further analysis, the mean distance of 4 test trials was calculated. A higher scores indicates a better outcome.



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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Symptoms of shoulder impingement on the dominant side for at least 3 months and at least 3 of the following tests are considered positive

    • Jobe
    • Hawkins
    • Neer
    • Painful arc during elevation
    • Pain or lack of force production with isometric external rotation
    • Apprehension test
    • Relocation test
  • Performing overhead sports at least 3 hours/week
  • Shoulder pain interferes with sports activities
  • They have not had treatment for this shoulder pain

Exclusion Criteria:

  • History of shoulder dislocation or subluxation
  • History of orthopedic surgery
  • No complaints of pain or dysfunction in the upper limb (except impingement related complaints in the dominant shoulder), lower limb or spine at the last 6 months
  • Currently taking nonsteroidal anti-inflammatory medication
  • Received a steroid injection in the past 12 months
  • Participating in another study
  • Known systemic diseases
  • Known structural diseases

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): NCT02670174


Locations
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Belgium
Vakgroep REVAKI (Ghent University - Ghent University hospital)
Ghent, Belgium, 9000
Sponsors and Collaborators
University Ghent
Investigators
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Principal Investigator: Ann Cools, PT, PhD University Ghent
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Responsible Party: Patrick Van Gelder, Prof dr. Ann Cools, University Ghent
ClinicalTrials.gov Identifier: NCT02670174    
Other Study ID Numbers: 2015/0816
First Posted: February 1, 2016    Key Record Dates
Last Update Posted: October 11, 2019
Last Verified: October 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Patrick Van Gelder, University Ghent:
Shoulder impingement syndrome
Overhead athletes
Kinetic chain
Exercise treatment
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