{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:13Z","timestamp":1787028313919,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2020,8,1]],"date-time":"2020-08-01T00:00:00Z","timestamp":1596240000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012925","name":"Department of Health, Northern Ireland","doi-asserted-by":"publisher","award":["RRG\/3100\/05"],"award-info":[{"award-number":["RRG\/3100\/05"]}],"id":[{"id":"10.13039\/100012925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Shoulder pain is common in primary care. The management of subacromial impingement (SAI) can include corticosteroid injections and physiotherapy. Physiotherapy can be on an individual or group basis. Aim: To examine the clinical effectiveness and make an economic analysis of individual versus group physiotherapy, following corticosteroid injection for SAI. Design and Setting: A single-blind, open-label, randomised equivalence study comparing group and individual physiotherapy. Patients referred by local general practitioners and physiotherapists were considered for inclusion. Method: Patients were randomised to individual or group physiotherapy groups, and all received corticosteroid injection before physiotherapy. The primary outcome measure was shoulder pain and disability index (SPADI) at 26 weeks. An economic analysis was conducted. Results and Conclusion: 136 patients were recruited, 68 randomised to each group. Recruitment was 68% of the target 200 participants. SPADI (from baseline to 26 weeks) demonstrated a difference (SE) in mean change between groups of \u22120.43 (5.7) (p-value = 0.050001), and the TOST (two-one-sided test for equivalence) 90% CI for this difference was (\u221210.0 to 9.14). This was borderline. In a secondary analysis using inputted data, patients without SPADI at week 26 were analysed by carrying forward scores at week 12 (mean difference (95% CI) = \u22120.14 (\u22127.5 to 7.3), p-value = 0.014). There is little difference in outcome at 26 weeks. Group physiotherapy was cheaper to deliver per patient (\u00a3252 versus \u00a384). Group physiotherapy for SAI produces similar clinical outcomes to individual physiotherapy with potential cost savings. Due to low recruitment to our study, firm conclusions are difficult and further research is required to give a definitive answer to this research question. (NCT Clinical Trial Registration Number NCT04058522).<\/jats:p>","DOI":"10.3390\/ijerph17155565","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T06:16:47Z","timestamp":1596435407000},"page":"5565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Effectiveness of Individual or Group Physiotherapy in the Management of Sub-Acromial Impingement: A Randomised Controlled Trial and Health Economic Analysis"],"prefix":"10.3390","volume":"17","author":[{"given":"Ian","family":"Ryans","sequence":"first","affiliation":[{"name":"General Practice Elective Care Service (MSK), Eastern GP Federations, Belfast, BT8 7AR, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhona","family":"Galway","sequence":"additional","affiliation":[{"name":"Rheumatology Department, South Eastern Health and Social Services Trust, Dundonald BT16 1RH, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Harte","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Ulster University, Belfast BT37 0QB, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rejina","family":"Verghis","sequence":"additional","affiliation":[{"name":"Northern Ireland Clinical Trials Unit, Belfast BT12 6BA, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Agus","sequence":"additional","affiliation":[{"name":"Northern Ireland Clinical Trials Unit, Belfast BT12 6BA, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4123-9806","authenticated-orcid":false,"given":"Neil","family":"Heron","sequence":"additional","affiliation":[{"name":"Department of General Practice, Queen\u2019s University Belfast, Belfast BT7 1NN, UK"},{"name":"Department of Primary Care, Keele University, Staffordshire ST5 5BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"McKane","sequence":"additional","affiliation":[{"name":"Rheumatology Department, South Eastern Health and Social Services Trust, Dundonald BT16 1RH, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/03009740310004667","article-title":"Prevalence and incidence of shoulder pain in the general population: A systematic review","volume":"33","author":"Luime","year":"2004","journal-title":"Scand. J. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1136\/bmj.313.7057.601","article-title":"The Clinical Course of Shoulder Pain: Prospective Cohort Study in Primary Care","volume":"313","author":"Croft","year":"1996","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Virta, L., Joranger, P., Brox, J.I., and Eriksson, R. (2012). Costs of shoulder pain and resource use in primary health care: A cost-of-illness study in Sweden. BMC Musculoskelet. Disord., 13.","DOI":"10.1186\/1471-2474-13-17"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jse.2005.04.006","article-title":"Deficits in shoulder function and general health associated with sixteen common shoulder diagnoses: A study of 2674 patients","volume":"15","author":"Largacha","year":"2006","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_5","first-page":"e8","article-title":"Subacromial impingement syndrome","volume":"4","author":"Umer","year":"2012","journal-title":"Orthop. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.math.2015.03.013","article-title":"Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration","volume":"20","author":"Abdulla","year":"2015","journal-title":"Man. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.physio.2016.11.003","article-title":"Physiotherapy for patients with shoulder pain in primary care: A descriptive study of diagnostic- and therapeutic management","volume":"103","author":"Karel","year":"2017","journal-title":"Physiotherapy"},{"key":"ref_8","first-page":"CD004016","article-title":"Corticosteroid injections for shoulder pain","volume":"1","author":"Buchbinder","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","first-page":"CD012224","article-title":"Manual therapy and exercise for rotator cuff disease","volume":"6","author":"Page","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3109\/17453674.2014.920991","article-title":"Guideline for diagnosis and treatment of subacromial pain syndrome. A multidisciplinary review by the Dutch Orthopaedic Association","volume":"85","author":"Diercks","year":"2014","journal-title":"Acta Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1136\/bjsports-2015-095410","article-title":"Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis","volume":"51","author":"Hayes","year":"2017","journal-title":"Br. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1093\/rheumatology\/ket149","article-title":"Cost effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: A trial based analysis","volume":"52","author":"Jowett","year":"2013","journal-title":"Rheumatology (Oxford)"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.jclinepi.2005.10.006","article-title":"A simple classification system was recommended for patients with restricted shoulder or neck range of motion","volume":"59","author":"Groenier","year":"2006","journal-title":"J. Clin. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1093\/ptj\/77.10.1079","article-title":"The shoulder pain and disability index: The construct validity and responsiveness of a region-specific disability measure","volume":"77","author":"Heald","year":"1997","journal-title":"Phys. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1002\/art.24396","article-title":"Measuring shoulder function: A systematic review of four questionnaires","volume":"61","author":"Roy","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_16","first-page":"727","article-title":"Measuring shoulder function with the Shoulder Pain and Disability Index","volume":"22","author":"Williams","year":"1995","journal-title":"J. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/00005650-199303000-00006","article-title":"The MOS 36-item Short Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs","volume":"31","author":"McHorney","year":"1993","journal-title":"Med. Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"EuroQol Group (1990). Euroqol\u2014A new facility for the measurement of health-related quality of life. Health Policy, 16, 199\u2013208.","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1192\/bjp.165.5.669","article-title":"A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria","volume":"165","author":"Abiodun","year":"1994","journal-title":"Br. J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1002\/art.10954","article-title":"Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo-controlled trial","volume":"48","author":"Carette","year":"2003","journal-title":"Arthritis Rheum."},{"key":"ref_21","unstructured":"Curtis, L. (2014). Unit Costs of Health and Social Care 2014, Personal Social Services Research Unit, University of Kent."},{"key":"ref_22","unstructured":"Department of Health (2014). NHS Reference Costs 2013\/2014, Department of Health."},{"key":"ref_23","unstructured":"Joint Formulary Committee (2015, January 29). British National Formulary. Available online: http:\/\/www.medicinescomplete.com."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jse.2013.12.026","article-title":"A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder","volume":"23","author":"Russell","year":"2014","journal-title":"J. Shoulder Elbow Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/PHM.0000000000000817","article-title":"Effectiveness of a Group Physiotherapy Intervention in Nontraumatic, Inoperable Painful Shoulder: A Randomized Clinical Trial","volume":"97","year":"2018","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/msc.1191","article-title":"Exercise for chronic musculoskeletal pain: A biopsychosocial approach","volume":"15","author":"Booth","year":"2017","journal-title":"Musculoskelet. Care"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/15\/5565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:53:37Z","timestamp":1760176417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/15\/5565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,1]]},"references-count":26,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2020,8]]}},"alternative-id":["ijerph17155565"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17155565","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,1]]}}}