Effects of Movement Representation Techniques With Sensorimotor Training for Rotator Cuff Related Shoulder Pain

The Hong Kong Polytechnic University122 enrolled

Overview

The aim of this study is to evaluate the efficacy of 12 weeks of sensorimotor training with movement representation techniques for reducing pain intensity in people with rotator cuff related shoulder pain, relative to standard care. Besides, the secondary aim of this study is to explore the mechanisms underlying the effects of central mechanism treatment in people with rotator cuff related shoulder pain. A total of 122 older adults aged 50 or above with the presence of shoulder pain for more than three months will be recruited and randomized into 12-weeks of movement representation techniques with sensorimotor training vs. standard care. Shoulder pain and disability Index (SPADI), changes in primary motor cortex (M1) using brain MRI, changes in subacromial space using ultrasound imaging, Widespread Pain Index (WPI), Pain Catastrophising Scale (PCS), and Fear-avoidance Beliefs questionnaires (FABQ) will be assessed at baseline and 12-week post intervention.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

122

Conditions

Rotator Cuff Related Shoulder Pain

Interventions

Sensorimotor training will be implemented with movement representation techniques using a standardized retraining sequence of a shoulder control exercise during arm elevation with 3 phases: Phase 1: Action Observation Training; Phase 2: Mirror therapy; and Phase 3: Sensorimotor training of the involved arm. Each session will last 60 minutes, with one supervised intervention session over the 12 weeks.

Eligibility

Sex: ALLMin age: 50 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged 50 or above * Presence of shoulder pain for more than three months * Clinical test showed 3/5 positive tests (painful arc, resisted external rotation, Neer test, Kennedy-Hawkins test, and Jobe test), and the intensity of pain being provoked should be ≥ 3/10 on an 11-point numeric pain rating scale (NPRS) * Structural changes of rotator cuff tendons using MRI or ultrasound imaging Exclusion Criteria: * History of trauma * Shoulder fracture, glenohumeral osteoarthritis, or arthritis in the acromioclavicular joint * Clinically suspected labrum lesion * Previous shoulder surgery or dislocation * Clinical signs of anterior shoulder instability * Clinical signs of frozen shoulders * Previous clinical treatment or corticosteroid injection for a shoulder injury within the last 12 months * Symptoms referred from or related to the spine; and (9) other competing diagnoses (i.e., rheumatoid arthritis, cancer, neurological disorders, fibromyalgia, or psychiatric illness).

Outcomes

Primary Outcomes

Pain intensity

Pain will be assessed using the pain sub-score of the Chinese Version of the Shoulder Pain and Disability Index. It is a validated self-administered questionnaire used to evaluate upper limb symptoms and functional limitations during daily activities. The questionnaire consists of 13 items with two subscales, i.e., pain intensity (five items) and disability (eight items), and each subscale-item will be summed to obtain a pain-score and a disability-score. The total of all items will be summed to obtain the final scores for each domain ranging from 0 to 100, with higher scores indicating more pain and disability. In the present study, the pain sub-score will be used as the measure of average pain intensity.

Time frame: Baseline and 12-weeks post-intervention

Secondary Outcomes

Cortical thickness in the primary motor cortex (M1) using brain MRI

The brain structure will be measured using structural and resting-state functional magnetic resonance imaging (fMRI) on a 3.0 T Siemens Prisma scanner. During the resting-state scan, the participants will be instructed to rest with their eyes closed while remaining stationary for 30 minutes. The regional cortical thickness of the brain region, the primary motor cortex (M1), will be extracted from T1-weighted MRI images.

Time frame: Baseline and 12 weeks post-intervention