Shoulder Rehabilitation Exercise Revealed Better Outcome in Patients with More Pain and Disability: Prospective Observational Study

Research Objectives: To examine the effects of shoulder rehabilitation exercises, with and without intra-articular (IA) steroid injection, across severity (pain and disability levels)

Design: A prospective observational study

Setting: This study was conducted at two tertiary care centers from March through November 2023.

Participants: One hundred shoulder pain patients participated in this study. Fifty-two patients underwent a combined treatment of IA steroid injections and exercise, while forty-eight patients engaged only in an exercise program. Both groups underwent exercise for three months. The severity distribution was mild 44, moderate 35, and severe 21.

Interventions: The total period of shoulder exercise was over three months. Participants were required to attend the hospital bi-weekly for exercise sessions, a maximum of six visits throughout the treatment duration.
The shoulder exercises program consisted of fifteen movements, each designed to enhance muscle strength and flexibility through upper limb and trunk movements, incorporating concentric, eccentric, and passive stretching techniques. All participants performed each item bilaterally, repeating it ten times in each limb. If participants exercised inaccurately during exercise execution, the operator corrected the posture. Additionally, participants were instructed to practice the exercises at their homes independently.
IA steroid injection was administered at the initial visit. After administering IA steroid injections, they engaged in the shoulder rehabilitation exercise program.

Main Outcome Measures: The Shoulder Pain and Disability Index (SPADI) was used to evaluate pain and functional impairment. Based on the SPADI total score, severity was classified as mild, moderate, and severe groups. Multivariate analysis of variance was used to assess the effects of IA steroid injection and severity on rehabilitation exercise.

Results: There were significant differences in the effects of rehabilitation exercises according to severity (Wilks’Λ=0.666, F(6,132)=4.954, p< 0.001). Severe patients showed the most notable improvements. While IA steroid injection did not significantly affect changes in SPADI scores (Wilks’Λ=0.937, F(3,66)=1.487, p=0.226), severe and moderate patients with IA steroid injection showed improvement in pain relief.

Conclusions: Well-managed rehabilitation exercise improved pain relief and function, particularly in patients with severe pain and disability. IA steroid injection did not affect the long-term effect of exercise. However, the synergy between pharmacological and physical therapies can complement each other and support severe to moderate patient recovery. To plan individualized rehabilitation strategies, severity and patient-specific factors must be considered.

Author(s) Disclosures: The authors declare that they have no known competing financial interests of personal relationships that could have appeared to influence the work reported in this poster.