Enhancing adherence and outcomes in rotator cuff-related shoulder pain: A randomized trial of individualized exercise sequencing.
Beom Chang Baek, Nackhwan Kim
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In 30 seconds
This single-center randomized controlled trial compared individualized, algorithm-based sequencing with random sequencing of the same 13 home exercises in adults with chronic rotator cuff-related shoulder pain. Of 55 participants assigned, 48 (87.3%) completed eight-week follow-up. Adherence was higher with individualized sequencing (median 4.0 cycles vs 1.0 cycle; p < 0.001), alongside greater improvement in SPADI and all secondary outcomes across follow-ups (all post hoc p < 0.001). The authors caution that the large treatment effect was likely mediated by adherence and that low compliance in the random-sequence group may not reflect usual practice.
Key findings
- Adherence was higher with individualized sequencing: median 4.0 cycles versus 1.0 cycle with random sequencing (p < 0.001).
- SPADI and all secondary outcomes improved more with individualized sequencing across follow-ups (all post hoc p < 0.001).
- Mixed-effects models showed steeper functional improvement in K-DASH and range of motion with individualized sequencing.
Why it matters
Exercise adherence can be a challenge in chronic rotator cuff-related shoulder pain. This trial suggests that how a home exercise programme is sequenced may influence both completion and patient outcomes, making programme design a potentially relevant consideration. The findings should be interpreted in light of the comparator group's low compliance and the possibility that adherence mediated much of the observed benefit.
What to keep in mind
The trial was single-center, and 48 of 55 participants completed follow-up. The authors note that low compliance in the random-sequence group may not reflect usual practice and that the large treatment effect was likely mediated by adherence.