Functional Ability and Quality of Life Status following Manual Therapy and Specific Exercise Conditioning in Subacromial Impingement Syndrome: A Randomised Controlled Study

Introduction: Subacromial Impingement Syndrome (SIS) is a common shoulder problem that leads to considerable functional loss and a decline in Quality of Life (QoL). Conservative treatment is the first line of management, often multimodal where physiotherapy is commonly recommended. But limited information is available regarding the combined effect of various treatments.

Aim: To evaluate the combined effect of manual therapy and specific exercise conditioning in improving function and QoL among patients with SIS and also to compare with the conventional therapy.

Materials and Methods: This single-blinded randomised controlled study was conducted in the rehabilitation center, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India, from January 2017 to February 2020. A total of 126 subjects were recruited and randomly allocated into two groups: Group 1 (n=63) received manual therapy and eccentric exercise, Group 2 (n=63) received conventional exercise, spread over three weeks followed by a home program for another nine weeks. Regional and self-rated functional limitations were obtained using the Shoulder Pain and Disability Index (SPADI) and Patient Specific Functional Scale (PSFS) at baseline, after 10 sessions of treatment and follow-up at 12 weeks with other clinical outcomes. A Short Form Health Survey (SF 36) was used to obtain QoL status at baseline and follow-up at 12 weeks. Data were analysed using one-way Analysis of Variance (ANOVA) and unpaired t-test.

Results: The mean age was 45.02±10.30 years and 45.12±11.42 years in groups 1 and 2, respectively. Male to female ratio was 25:21 and 30:21 in groups 1 and 2, respectively. All outcomes improved by three weeks and during follow-up at 12 weeks in both groups (p-value <0.00001 and p-value <0.0005, respectively). However, on between group analysis significant improvement was observed with pain intensity (p-value <0.0005), range (p-value <0.05), external rotator strength (p-value=0.016) and PSFS score (p-value=0.014) by three weeks. External rotator strength (p-value <0.0005), SPADI (p-value <0.0005), PSFS (p-value=0.035), physical (p-value=0.008) and mental (p-value=0.006) cumulative scores of SF 36 had significant improvement in group 1 during follow-up at 12 weeks.

Conclusion: The combined effect of manual therapy and specific exercise conditioning improved regional, self-rated functional ability and QoL among individuals with SIS.