Comparison of Supervised Rehabilitation and Home Exercise Programs in Subacromial Impingement Syndrome

Subacromial impingement syndrome (SAIS) is one of the most common causes of shoulder pain, leading to decreased range of motion, muscle weakness, functional limitations, and reduced quality of life. Exercise-based rehabilitation is considered a primary conservative treatment approach. However, access to supervised physiotherapy services may be limited due to long waiting times and healthcare system constraints. Home exercise programs may serve as an alternative, but evidence comparing their effectiveness with supervised rehabilitation remains limited.

This study is designed as a randomized controlled trial to compare the effectiveness of physiotherapist-supervised rehabilitation and home exercise programs in individuals with SAIS. A total of 63 participants who meet the inclusion criteria will be recruited and randomly assigned into three groups: supervised rehabilitation, home exercise, and control.

Randomization will be performed using an online randomization tool. Participants allocated to the supervised rehabilitation group will receive a structured rehabilitation program consisting of pain management modalities, range of motion exercises, strengthening exercises, and functional training under the supervision of a physiotherapist, five days per week for four weeks. The home exercise group will receive a structured exercise program including stretching, strengthening, and mobility exercises after a single training session and will continue the program independently at home. Participants in the control group will not receive any intervention during the study period and will be included in the supervised rehabilitation program after the final assessment.

Outcome measures will include pain intensity assessed by Visual Analog Scale, upper extremity function assessed by the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), shoulder range of motion measured by goniometer, grip strength measured by dynamometer, sleep quality assessed by a single-item sleep quality scale, and quality of life assessed by the WHOQOL-BREF. Assessments will be conducted at baseline and at the end of the 4-week intervention period.

The findings of this study will contribute to the literature by providing evidence on the comparative effectiveness of supervised rehabilitation and home-based exercise programs and may guide clinical decision-making in the management of SAIS.

• Supervised Rehabilitation Program (Behavioral): A physiotherapist-supervised rehabilitation program including pain management approaches, stretching exercises, range of motion exercises, scapular stabilization exercises, strengthening exercises, and activity modification training administered five days per week for four weeks.
• Home Exercise Program (Behavioral): A structured home exercise program including stretching, range of motion, scapular stabilization, and strengthening exercises performed independently at home for four weeks following an education session.

Primary outcomes

• Pain Intensity [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Pain intensity will be assessed using the Visual Analog Scale (0-10 cm) during rest, activity, and night pain. Higher scores indicate greater pain severity.

Secondary outcomes

• Upper Extremity Function [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Upper extremity function will be assessed using the Disabilities of the Arm, Shoulder and Hand Questionnaire-Short Form (DASH-SF; 0-100). Higher scores indicate greater disability.
• Shoulder Range of Motion [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Shoulder flexion, extension, abduction, internal rotation, and external rotation range of motion will be measured using a universal goniometer.
• Grip Strength [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Grip strength of the affected upper extremity will be assessed using a hand dynamometer.
• Sleep Quality [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Sleep quality will be assessed using the Single-Item Sleep Quality Scale (0-10). Higher scores indicate poorer sleep quality.
• Quality of Life-WHOQOL-BREF [Baseline (Day 0, prior to intervention) and Week 4 (end of intervention)]: Quality of life will be assessed using the WHOQOL-BREF questionnaire. Higher scores indicate better quality of life

Sex: All, ages: 30 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

* Voluntary participation in the study
* Literate in Turkish
* Aged between 30 and 65 years
* No visual or hearing impairment
* Diagnosed with unilateral subacromial impingement syndrome by a specialist physician
* Positive painful arc test, Infraspinatus test, and Hawkins-Kennedy test
* Pain during overhead activities

Exclusion Criteria:

* Presence of a mental or psychological disorder that may affect study findings
* Inadequate cooperation
* History of upper extremity fracture within the last 6 months
* Presence of cervical neurological symptoms
* Glenohumeral instability
* Acromioclavicular joint pathology
* Full-thickness rotator cuff tear or total rupture
* Signs of glenohumeral osteoarthritis
* History of frozen shoulder

• Results publication: Gutierrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Alvarez-Bueno C, Martinez-Vizcaino V, Cavero-Redondo I. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis. Phys Ther Sport. 2020 Jan;41:34-42. doi: 10.1016/j.ptsp.2019.11.003. Epub 2019 Nov 6. PMID 31726386
• Results publication: Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, Willems J, Winters J, van der Woude HJ; Dutch Orthopaedic Association. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014 Jun;85(3):314-22. doi: 10.3109/17453674.2014.920991. Epub 2014 May 21. PMID 24847788
• Results publication: Horowitz EH, Aibinder WR. Shoulder Impingement Syndrome. Phys Med Rehabil Clin N Am. 2023 May;34(2):311-334. doi: 10.1016/j.pmr.2022.12.001. Epub 2023 Feb 26. PMID 37003655