A group approach to shoulder pain
Monash University researcher Dr Luke Perraton has received a grant from the Physiotherapy Research Foundation to investigate the feasibility of a new group exercise approach to the treatment of rotator cuff-related shoulder pain. We talk to him here about the project.
Rotator cuff-related shoulder pain (RCRSP) is a common complaint, encompassing tendinopathy, sub-acromial pain and rotator cuff tears.
However, many patients do not receive the clinically recommended care—6-12 weeks of conservative care prior to considering imaging or surgery.
‘Shoulder pain typically lasts a long time.
'It can affect people’s quality of life.
'It’s costly, it’s burdensome for them and it’s common,’ says Dr Luke Perraton, an APA Musculoskeletal Physiotherapist, an APA Sports and Exercise Physiotherapist and a researcher at Monash University.
‘We know from a research and practice perspective that many people don’t receive high quality care for shoulder pain and a lot of people end up going down the pathway of imaging and surgery.
'I’ve seen that myself.’
His current research project aims to change that by showing that a group intervention program is a feasible way to deliver high-quality evidence-based exercise and education to patients with RCRSP.
Drawing inspiration for group-based interventions from the successful GLA:D program for treating knee and hip osteoarthritis, the project is part of a larger research program led by Associate Professor Peter Malliaras, with the potential to change best practice for people with shoulder pain.
‘We know that surgery isn’t always the most effective treatment for shoulder pain and that exercise and education are high value as a treatment, but people aren’t necessarily always getting that intervention.
'If we can contribute to developing a high value, fun, innovative intervention for people with shoulder pain, and if it’s feasible and economical, it’s going to help practitioners who are at the business end of treating people with shoulder pain and it’s going to help their patients because they’ve got a program they can follow,’ Luke says.
‘We already know from previous research that group-based exercise, home-based exercise and individually supervised exercise are all effective for people with rotator cuff-related shoulder pain, but what we don’t have is strong, robust evidence for group exercise programs.’
Luke says the initial study, which recently received a 2021 Seeding Grant from the Physiotherapy Research Foundation with support from PRF corporate partner WorkSafe Victoria, will provide data about the feasibility of a group exercise program for people with RCRSP that will underpin the study design for a larger randomised controlled trial.
The pilot study’s group exercise and education program will last for 12 weeks and will look at factors including rate of recruitment, compliance with the program, retention of participants, clinical outcomes (pain and function) and economic factors.
A control group will be given access to the education component of the intervention and a list of exercises but will not engage in the physiotherapist-led group classes.
Depending on the speed of enrolling participants, Luke expects to complete the analysis in the first half of 2023.
The trial is currently awaiting university ethics approval.
In the meantime, Luke has been getting trial sites set up and physiotherapists trained to deliver the program.
The PRF funding will support the physiotherapists who will deliver the group exercise and education program as well as the development of resources and advertising.
Luke hopes that the study will eventually lead to a long-term change in the way that RCRSP is treated by providing a practical alternative for patients presenting to their doctor or physiotherapist with shoulder pain.
‘My motivation for doing this research is to provide stronger evidence to inform the care of people in the clinic and to help the large number of people affected by shoulder pain,’ he says.
‘Ultimately we’d like to develop a very practical and useable intervention that will help improve outcomes for people with shoulder pain.’
This grant is supported by PRF corporate partner WorkSafe Victoria.
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