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  • New in the Literature: Subacromial Impingement Syndrome (BMJ 2012 Feb 20 [Epub ahead of print])

    A specific exercise strategy that focuses on strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers is effective in reducing pain and improving shoulder function in patients with persistent subacromial impingement syndrome, say authors of an article published online in BMJ. By extension, they add, this exercise strategy reduced the need for arthroscopic subacromial decompression within the 3-month timeframe used in the study.

    This randomized, participant and single assessor blinded controlled study was conducted in an orthopedic department in a Swedish university hospital. Orthopedic specialists recruited 102 patients with longstanding (more than 6 months) persistent subacromial impingement syndrome that did not respond to earlier conservative treatment. 

    The specific exercise strategy consisted of strengthening eccentric exercises for the rotator cuff and concentric/eccentric exercises for the scapula stabilizers in combination with manual mobilization. The control exercise program consisted of unspecific movement exercises for the neck and shoulder. Patients in both groups received 5 to 6 individual guided treatment sessions during 12 weeks. In between these supervised sessions the participants performed home exercises once or twice a day for 12 weeks.

    The primary outcome was the Constant-Murley shoulder assessment score evaluating shoulder function and pain. Secondary outcomes were patients' global impression of change because of treatment and decision regarding surgery.

    Most (97, 95%) participants completed the 12-week study. There was a significantly greater improvement in the Constant-Murley score in the specific exercise group than in the control exercise group (24 points vs 9 points). Significantly more patients in the specific exercise group reported successful outcome (defined as large improvement or recovered) in the patients' global assessment of change because of treatment— 69% (35/51) vs 24% (11/46); odds ratio 7.6 (95% confidence interval 3.1 to 18.9). A significantly lower proportion of patients in the specific exercise group subsequently chose to undergo surgery—20% (10/51) vs 63% (29/46); odds ratio 7.7 (95% confidence interval 3.1 to 19.4).

    APTA Testifies at HHS Quality Subcommittee

    Yesterday, APTA testified on the use of functional mobility and self-management measures at the Department of Health and Human Services' (HHS) National Committee on Vital and Health Statistics Quality Subcommittee on Patient Quality Measures.

    Nearly 20 quality experts spoke on understanding patient/consumer health and health care decision-making needs and the measures and data to support health and decision making, using patient experience and satisfaction measures in assessing whether consumers/patients achieve their goals and expectations, and using patient preference measures in selection of insurance coverage, health providers, and treatment options. 

    APTA's testimony, delivered by Heather L. Smith, PT, MPH, program director of quality, included information about functional mobility measures that are currently being used. The association described barriers to adopting certain quality measures, such as practitioners' resistance to change, the time needed to administer and interpret results, and access and cost issues related to technology, as well as presented strategies that could be employed to overcome these barriers.    

    In addition to APTA, other panelists who presented on measures of functional mobility and self-management included John Hough, DrPH, MPH, MBA, from the National Center on Health Statistics, and Matt Stiefel, MPA, of Kaiser Permanente.