Back to resultsInfluence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement
Primary Purpose
Shoulder Impingement Syndrome
Status
Completed
Phase
Not Applicable
Locations
Belgium
Study Type
Interventional
Intervention
Traditional training
Separate kinetic chain training
Integrated kinetic chain training
Sponsored by
About this trial
This is an interventional treatment trial for Shoulder Impingement Syndrome focused on measuring Shoulder impingement syndrome, Overhead athletes, Kinetic chain, Exercise treatment
Eligibility 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
Sites / Locations
- Vakgroep REVAKI (Ghent University - Ghent University hospital)
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Active Comparator
Experimental
Experimental
Arm Label
Traditional training
Separate kinetic chain training
Integrated kinetic chain training
Arm Description
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.
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.
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.
Outcomes
Primary Outcome Measures
Changes in Shoulder Pain And Disability Index (SPADI) score
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
Changes in Western Ontario Shoulder Stability index (WOSI) score
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
Subjective perception of shoulder improvement
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
Changes in shoulder muscle isokinetic strength (Biodex system 4)
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.
Changes in shoulder scapular isokinetic strength
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.
Changes in scapular dyskinesis
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.
Changes in functional tests for the upper limb measured with the Y Balance Test
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.
Return To Play (RTP)
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?
Changes in functional tests for the upper limb measured with the Seated Medicine Ball Throw
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.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT02670174
Brief Title
Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement
Official Title
Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Shoulder Impingement Syndrome
Study Type
Interventional
2. Study Status
Record Verification Date
October 2019
Overall Recruitment Status
Completed
Study Start Date
September 2015 (undefined)
Primary Completion Date
June 2018 (Actual)
Study Completion Date
June 2018 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Ghent
4. Oversight
Data Monitoring Committee
No
5. Study Description
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.
Detailed Description
Participant are randomly assigned in 3 home exercise groups.
The traditional program: consists of solely strengthening the rotator cuff muscles and scapular muscles (e.g. external rotation)
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)
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).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Shoulder Impingement Syndrome
Keywords
Shoulder impingement syndrome, Overhead athletes, Kinetic chain, Exercise treatment
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Subjects are randomly assigned in 3 parallel intervention groups. They cannot participate in 2 or more intervention groups.
Masking
Investigator
Allocation
Randomized
Enrollment
38 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Traditional training
Arm Type
Active Comparator
Arm Description
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.
Arm Title
Separate kinetic chain training
Arm Type
Experimental
Arm Description
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.
Arm Title
Integrated kinetic chain training
Arm Type
Experimental
Arm Description
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.
Intervention Type
Other
Intervention Name(s)
Traditional training
Intervention Type
Other
Intervention Name(s)
Separate kinetic chain training
Intervention Type
Other
Intervention Name(s)
Integrated kinetic chain training
Primary Outcome Measure Information:
Title
Changes in Shoulder Pain And Disability Index (SPADI) score
Description
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
Time Frame
At baseline and within one week after the 6-weeks training program
Title
Changes in Western Ontario Shoulder Stability index (WOSI) score
Description
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
Time Frame
At baseline and within one week after the 6-weeks training program
Title
Subjective perception of shoulder improvement
Description
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)
Time Frame
6-weeks training program
Secondary Outcome Measure Information:
Title
Changes in shoulder muscle isokinetic strength (Biodex system 4)
Description
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.
Time Frame
at baseline and within one week after the 6-weeks training program
Title
Changes in shoulder scapular isokinetic strength
Description
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.
Time Frame
at baseline and within one week after the 6-weeks training program
Title
Changes in scapular dyskinesis
Description
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.
Time Frame
at baseline and within one week after the 6-weeks training program
Title
Changes in functional tests for the upper limb measured with the Y Balance Test
Description
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.
Time Frame
at baseline and within one week after the 6-weeks training program
Title
Return To Play (RTP)
Description
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?
Time Frame
up to one week after the 6-weeks training program
Title
Changes in functional tests for the upper limb measured with the Seated Medicine Ball Throw
Description
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.
Time Frame
at baseline and within one week after the 6-weeks training program
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility 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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ann Cools, PT, PhD
Organizational Affiliation
University Ghent
Official's Role
Principal Investigator
Facility Information:
Facility Name
Vakgroep REVAKI (Ghent University - Ghent University hospital)
City
Ghent
ZIP/Postal Code
9000
Country
Belgium
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Influence of Kinetic Chain Training on the Treatment Outcome of Overhead Athletes With Impingement
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