Research Report
Effectiveness of Standardized Physical
Therapy Exercises for Patients With
Difficulty Returning to Usual Activities
After Decompression Surgery for
Subacromial Impingement Syndrome:
Randomized Controlled Trial
David Høyrup Christiansen, Poul Frost, Deborah Falla, Jens Peder Haahr,
Lars Henrik Frich, Linda Christie Andrea, Susanne Wulff Svendsen
Background. Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning
to usual activities, special efforts may be needed to improve shoulder function.
Objective. The purpose of this study was to evaluate the effectiveness at 3 and 12 months
of a standardized physical therapy exercise intervention compared with usual care in patients
with difficulty returning to usual activities after subacromial decompression surgery.
Design. A multicenter randomized controlled trial was conducted.
Setting. The study was conducted in 6 public departments of orthopedic surgery, 2
departments of occupational medicine, and 2 physical therapy training centers in Central
Denmark Region.
Patients. One hundred twenty-six patients reporting difficulty returning to usual activities
at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery
participated.
Intervention. A standardized exercise program consisting of physical therapistsupervised individual training sessions and home training was used.
Outcome Measures. The primary outcome measure was the Oxford Shoulder Score.
Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs
Questionnaire.
Results. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients,
respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford
Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of
2.0 (95% confidence interval??0.5, 4.6), and at 12 months, with an adjusted mean difference
of 5.8 (95% confidence interval?2.8, 8.9). Significantly larger improvements for the exercise
group were observed for most secondary and supplementary outcome measures.
Limitations. The nature of the exercise intervention did not allow blinding of patients and
D.H. Christiansen, PT, PhD,
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