Comparing the effect of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome: a randomized controlled trial

Abstract

Purpose

To compare the short and medium-term effects of physiotherapy plus corticosteroid injection (combined) with physiotherapy alone on pain intensity, disability, Quality of Life (QoL), and treatment effectiveness in patients with Subacromial Pain Syndrome (SAPS).

Methods

In this double-blind, parallel Randomized Controlled Trial (RCT), 50 patients with SAPS were randomly assigned into combined (N = 25, a single injection 3–6 days before physiotherapy) and physiotherapy alone group (N = 25). Pain, disability, QoL, and treatment-effectiveness were measured at pre-intervention, post-intervention, and 3 and 6-month follow-up with Visual Analog Scale (VAS), Shortened Disability of the Arm, Shoulder, and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI) (primary outcome measure), Western Ontario Rotator Cuff (WORC), and Global Rating of Change (GRC) respectively. A 2 × 4 (group × time) mixed model analysis of variance (ANOVA) was applied for analysis.

Results

The ANOVA revealed statistically significant group-in-time interaction for all outcome measures (p-value < 0.05). The independent t-test showed more effectiveness in the combined group at medium-term, as the mean scores of almost all outcome measures were substantially lesser (p < 0.01). Moreover, in short-time, despite a greater number of patients stating “completely recovered” in the combined group, there was no statistically significant difference between groups.

Conclusions

Effects of physiotherapy plus corticosteroid injection could be more long-lasting than physiotherapy alone in improving pain intensity, disability, QoL, and treatment effectiveness in patients with SAPS.

Trial registration number

IRCT20201010048980N1.

IMPLICATIONS FOR REHABILITATION

• Shoulder pain is common, persistent, and predominantly results from subacromial pain syndrome (SAPS).

• Physiotherapy and corticosteroid injections are effective interventions for this condition.

• Comprehensive physiotherapy alone can be as effective as corticosteroid injection combined with physiotherapy in the short term.

• A combined approach versus physiotherapy alone may have more medium-term effects on SAPS patients’ pain, disability, quality of life, and treatment effectiveness.

Keywords:

• Subacromial pain syndrome
• physiotherapy
• corticosteroid injection
• pain intensity
• disability
• quality of life

Acknowledgement

This study is part of MSc thesis of Mr. Javad Raeesi. Special thanks to Mashhad University of Medical Sciences (MUMS) for the support [Master thesis grant no: 981570]. Also, we acknowledge the staff of the Rehabilitation section of the Ghem Hospital, MUMS, IR; especially Mr Zarandi, who provided valuable assistance in sample collection.

This work was supported by a MSc thesis grant from Mashhad University of Medical Sciences (MUMS), Mashhad, Iran [Master thesis grant no: 981570].

Disclosure statement

None of the authors has any financial or other interests relating to the manuscript to be submitted for publication in the Journal of Disability and Rehabilitation.