Daniel I. Rhon, PT, DPT, DSc; Robert B. Boyles, PT, DSc; Joshua A. Cleland, PT, PhD
Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or Department of Defense.
Acknowledgment: The authors thank Dr. David Brown, sports medicine physician, who administered the CSIs in this trial.
Grant Support: By Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2199.
Reproducible Research Statement:Study protocol: Published and available (29). Statistical code: Available from Dr. Rhon (email@example.com). Data set: Available after execution of a Cooperative Research and Development Agreement and Data Use Agreement with the appropriate Department of Defense regulatory agencies. Contact Dr. Rhon (firstname.lastname@example.org) if interested.
Requests for Single Reprints: Daniel I. Rhon, PT, DPT, DSc, Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234; e-mail, email@example.com.
Current Author Addresses: Dr. Rhon: Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Dr. Boyles: University of Puget Sound, School of Physical Therapy, 1500 North Warner Street, Tacoma, WA 98416.
Dr. Cleland: Franklin Pierce University, Physical Therapy Program, 670 North Commercial Street, Suite 301, Manchester, NH 03101.
Author Contributions: Conception and design: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Analysis and interpretation of the data: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Drafting of the article: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Critical revision of the article for important intellectual content: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Final approval of the article: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Provision of study materials or patients: D.I. Rhon, R.B. Boyles, J.A. Cleland.
Statistical expertise: D.I. Rhon.
Obtaining of funding: D.I. Rhon, J.A. Cleland.
Administrative, technical, or logistic support: D.I. Rhon, R.B. Boyles.
Collection and assembly of data: D.I. Rhon, R.B. Boyles.
Rhon DI, Boyles RB, Cleland JA. One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome: A Pragmatic Randomized Trial. Ann Intern Med. 2014;161:161-169. doi: 10.7326/M13-2199
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Published: Ann Intern Med. 2014;161(3):161-169.
Corticosteroid injections (CSIs) and physical therapy are used to treat patients with the shoulder impingement syndrome (SIS) but have never been directly compared.
To compare the effectiveness of 2 common nonsurgical treatments for SIS.
Randomized, single-blind, comparative-effectiveness, parallel-group trial. (ClinicalTrials.gov: NCT01190891)
Military hospital–based outpatient clinic in the United States.
104 patients aged 18 to 65 years with unilateral SIS between June 2010 and March 2012.
Random assignment into 2 groups: 40-mg triamcinolone acetonide subacromial CSI versus 6 sessions of manual physical therapy.
The primary outcome was change in Shoulder Pain and Disability Index scores at 1 year. Secondary outcomes included the Global Rating of Change scores, the Numeric Pain Rating Scale scores, and 1-year health care use.
Both groups demonstrated approximately 50% improvement in Shoulder Pain and Disability Index scores maintained through 1 year; however, the mean difference between groups was not significant (1.5% [95% CI, −6.3% to 9.4%]). Both groups showed improvements in Global Rating of Change scale and pain rating scores, but between-group differences in scores for the Global Rating of Change scale (0 [CI, −2 to 1]) and pain rating (0.4 [CI, −0.5 to 1.2]) were not significant. During the 1-year follow-up, patients receiving CSI had more SIS-related visits to their primary care provider (60% vs. 37%) and required additional steroid injections (38% vs. 20%), and 19% needed physical therapy. Transient pain from the CSI was the only adverse event reported.
The study occurred at 1 center with patients referred to physical therapy.
Both groups experienced significant improvement. The manual physical therapy group used less 1-year SIS-related health care resources than the CSI group.
Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.
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