{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T05:00:32Z","timestamp":1771045232215,"version":"3.50.1"},"reference-count":55,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/501100005878","name":"Terveyden Tutkimuksen Toimikunta","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005878","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004012","name":"Jane ja Aatos Erkon S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004012","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Sigrid Juselius Foundation"},{"name":"Competitive Research Fund of Pirkanmaa Hospital District"},{"name":"Competitive Research Fund of Helsinki University Central Hospital District"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,3,9]]},"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Arthroscopic subacromial decompression (ASD) is the most commonly performed surgical intervention for shoulder pain, yet evidence on its efficacy is limited. The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage. The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy (DA) in patients with shoulder impingement syndrome (SIS), where DA differs only by the lack of subacromial decompression. A third group of supervised progressive exercise therapy (ET) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Analysis<\/jats:title>\n                    <jats:p>Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre, three-group randomised controlled study. We performed two-fold concealed allocation, first by randomising patients to surgical (ASD or DA) or conservative (ET) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio. Our two primary outcomes are pain at rest and at arm activity, assessed using visual analogue scale (VAS). We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95% CI at 24 months. Our secondary outcomes are functional assessment (Constant score and Simple shoulder test), quality of life (15D and SF-36), patient satisfaction, proportions of responders and non-responders, reoperations\/treatment conversions, all at 2 years post-randomisation, as well as adverse effects and complications. We recruited a total of 210 patients from three tertiary referral centres. We will conduct the primary analysis on the intention-to-treat basis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and Dissemination<\/jats:title>\n                    <jats:p>The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>NCT00428870; Pre-results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-014087","type":"journal-article","created":{"date-parts":[[2017,6,6]],"date-time":"2017-06-06T20:10:13Z","timestamp":1496779813000},"page":"e014087","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Finnish Subacromial Impingement Arthroscopy Controlled Trial (FIMPACT): a protocol for a randomised trial comparing arthroscopic subacromial decompression and diagnostic arthroscopy (placebo control), with an exercise therapy control, in the treatment of shoulder impingement syndrome"],"prefix":"10.1136","volume":"7","author":[{"given":"Mika","family":"Paavola","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antti","family":"Malmivaara","sequence":"additional","affiliation":[{"name":"National Institute for Health and Welfare, Center for Health and Social Economics, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simo","family":"Taimela","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kari","family":"Kanto","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hatanp\u00e4\u00e4 City Hospital, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teppo LN","family":"J\u00e4rvinen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,6,6]]},"reference":[{"key":"2025121409101080000_7.5.e014087.1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3109\/17453674.2014.977703","article-title":"Declining incidence of acromioplasty in Finland","volume":"86","author":"Paloneva","year":"2015","journal-title":"Acta Orthop"},{"key":"2025121409101080000_7.5.e014087.2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01003"},{"key":"2025121409101080000_7.5.e014087.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b3360"},{"key":"2025121409101080000_7.5.e014087.4","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.920991"},{"key":"2025121409101080000_7.5.e014087.5","doi-asserted-by":"publisher","DOI":"10.1097\/BLO.0b013e31802fc175"},{"key":"2025121409101080000_7.5.e014087.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2007.03.008"},{"key":"2025121409101080000_7.5.e014087.7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S0268-0033(03)00047-0","article-title":"Anatomical and biomechanical mechanisms of subacromial impingement syndrome","volume":"18","author":"Michener","year":"2003","journal-title":"Clin Biomech"},{"key":"2025121409101080000_7.5.e014087.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.01.040"},{"key":"2025121409101080000_7.5.e014087.9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.2106\/00004623-197254010-00003","article-title":"Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report","volume":"54","author":"Neer","year":"1972","journal-title":"J Bone Joint Surg Am"},{"key":"2025121409101080000_7.5.e014087.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.02.029"},{"key":"2025121409101080000_7.5.e014087.11","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00364"},{"key":"2025121409101080000_7.5.e014087.12","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000510","article-title":"Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis","volume":"94","author":"Dong","year":"2015","journal-title":"Medicine"},{"key":"2025121409101080000_7.5.e014087.13","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-10-129."},{"key":"2025121409101080000_7.5.e014087.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.307.6909.899"},{"key":"2025121409101080000_7.5.e014087.15","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2004.021188"},{"key":"2025121409101080000_7.5.e014087.16","doi-asserted-by":"publisher","DOI":"10.1302\/2046-3758.27.2000163"},{"key":"2025121409101080000_7.5.e014087.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7004.551"},{"key":"2025121409101080000_7.5.e014087.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g3253"},{"key":"2025121409101080000_7.5.e014087.19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1302696"},{"key":"2025121409101080000_7.5.e014087.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-0725-y","article-title":"The CSAW Study (Can Shoulder Arthroscopy Work?) - a placebo-controlled surgical intervention trial assessing the clinical and cost effectiveness of arthroscopic subacromial decompression for shoulder pain: study protocol for a randomised controlled trial","volume":"16","author":"Beard","year":"2015","journal-title":"Trials"},{"key":"2025121409101080000_7.5.e014087.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(87)80061-0"},{"key":"2025121409101080000_7.5.e014087.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.03.021"},{"key":"2025121409101080000_7.5.e014087.23","first-page":"164","article-title":"A clinical method of functional Assessment of the shoulder","volume":"160","author":"Constant","year":"1987","journal-title":"Clin Orthop Relat Res"},{"key":"2025121409101080000_7.5.e014087.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2014.07.003"},{"key":"2025121409101080000_7.5.e014087.25","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(95)80018-2"},{"key":"2025121409101080000_7.5.e014087.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2006.07.003"},{"key":"2025121409101080000_7.5.e014087.27","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01296"},{"key":"2025121409101080000_7.5.e014087.28","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002086"},{"key":"2025121409101080000_7.5.e014087.29","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-008-9317-6"},{"key":"2025121409101080000_7.5.e014087.30","unstructured":"Bowling A . Measuring health. A review of quality of life measurement scales. 3rd ed. Berkshire: BMJ Publishing Group, 2004."},{"key":"2025121409101080000_7.5.e014087.31","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"2025121409101080000_7.5.e014087.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7351.1417"},{"key":"2025121409101080000_7.5.e014087.33","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1305189"},{"key":"2025121409101080000_7.5.e014087.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.01.008"},{"key":"2025121409101080000_7.5.e014087.35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.285063"},{"key":"2025121409101080000_7.5.e014087.36","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/00003086-198303000-00010","article-title":"2nd. impingement lesions","volume":"173","author":"Neer","year":"1983","journal-title":"Clin Orthop Relat Res"},{"key":"2025121409101080000_7.5.e014087.37","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000510","article-title":"Treatments for shoulder impingement syndrome: a PRISMA systematic review and network meta-analysis","volume":"94","author":"Dong","year":"2015","journal-title":"Medicine"},{"key":"2025121409101080000_7.5.e014087.38","doi-asserted-by":"crossref","first-page":"641","DOI":"10.3109\/17453674.2015.1033309","article-title":"Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?","volume":"86","author":"Ketola","year":"2015","journal-title":"Acta Orthop"},{"key":"2025121409101080000_7.5.e014087.39","doi-asserted-by":"crossref","first-page":"5","DOI":"10.5312\/wjo.v3.i1.5","article-title":"Analyses of possible risk factors for subacromial impingement syndrome","volume":"3","author":"Tangtrakulwanich","year":"2012","journal-title":"World J Orthop"},{"key":"2025121409101080000_7.5.e014087.40","first-page":"228","article-title":"April EW The morphology of the acromion and its relationship to rotator cuff tears","volume":"10","author":"Bigliani LU","year":"1986","journal-title":"Orthop Trans"},{"key":"2025121409101080000_7.5.e014087.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.11.011"},{"key":"2025121409101080000_7.5.e014087.42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1505467"},{"key":"2025121409101080000_7.5.e014087.43","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1508502"},{"key":"2025121409101080000_7.5.e014087.44","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-009655","article-title":"To what extent are surgery and invasive procedures effective beyond a placebo response? a systematic review with meta-analysis of randomised, sham controlled trials","volume":"5","author":"Jonas","year":"2015","journal-title":"BMJ Open"},{"key":"2025121409101080000_7.5.e014087.45","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7211.652"},{"key":"2025121409101080000_7.5.e014087.46","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.650"},{"key":"2025121409101080000_7.5.e014087.47","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d2175"},{"key":"2025121409101080000_7.5.e014087.48","first-page":"121","article-title":"Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone--does it really matter? a systematic review","volume":"31","author":"Donigan","year":"2011","journal-title":"Iowa Orthop J"},{"key":"2025121409101080000_7.5.e014087.49","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5496"},{"key":"2025121409101080000_7.5.e014087.50","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7132.690"},{"key":"2025121409101080000_7.5.e014087.51","doi-asserted-by":"crossref","DOI":"10.1186\/1745-6215-8-31","article-title":"Responder analyses and the assessment of a clinically relevant treatment effect","volume":"8","author":"Snapinn","year":"2007","journal-title":"Trials"},{"key":"2025121409101080000_7.5.e014087.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.03.021"},{"key":"2025121409101080000_7.5.e014087.53","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e5278"},{"key":"2025121409101080000_7.5.e014087.54","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-121-3-199408010-00008"},{"key":"2025121409101080000_7.5.e014087.55","first-page":"CD009020","article-title":"Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered","volume":"9","author":"Lenza","year":"2013","journal-title":"Cochrane Database Syst Rev"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-014087","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:10:22Z","timestamp":1765732222000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-014087"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":55,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2017,6,6]]},"published-print":{"date-parts":[[2017,5]]}},"alternative-id":["10.1136\/bmjopen-2016-014087"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-014087","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5]]}}}