Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Key points

1. 01Both groups improved substantially: Constant Score rose ~23 points and Shoulder Rating Questionnaire rose ~18 points in each group
2. 02No statistically significant difference between groups on any outcome measure at 3 months or 6 months follow-up
3. 03Heavy slow resistance training, effective for Achilles and patellar tendinopathy, did not add benefit over simpler home exercises for shoulder impingement
4. 04Compliance was similar between the supervised and home groups, contrary to expectation
5. 05The supervised program was far more intensive (6 motion, 8 strength, 4 stretching exercises) versus the home program (1 motion, 3 strength, 2 stretching exercises)

How it was conducted

Design

Randomised controlled trial with blinded assessor

Participants

126 patients with subacromial impingement syndrome (63 per group), mean age ~61 years

Groups

Supervised training regimen (STR): 6 motion, 8 strengthening, 4 stretching exercises 3x/week with physiotherapist; Home training regimen (HTR): 1 motion, 3 strengthening, 2 stretching exercises daily with written instructions

Duration

12 weeks of training plus 6-month follow-up assessment

Primary outcomes

Constant Score (CS, 0-100) and Shoulder Rating Questionnaire (SRQ, 17-100) at baseline and 6 months post-training

Analysis

Intention-to-treat with last observation carried forward for dropouts

What they found

• CS improved by 22.7 points in STR and 23.7 points in HTR from baseline to 6 months (p = 0.0001 within each group); inter-group difference was non-significant (mean difference -1.0, p = 0.77)
• SRQ improved by 17.7 points in STR and 18.1 points in HTR (p = 0.0001 within each group); inter-group difference non-significant (mean difference -0.42, p = 0.90)
• Passive abduction improved by 26.9 degrees in STR and 39.3 degrees in HTR (both p <= 0.003); inter-group difference non-significant (p = 0.11)
• Active abduction improved by 30.0 degrees in STR (p = 0.0001) and 39.2 degrees in HTR (p = 0.0001); inter-group difference non-significant (p = 0.25)
• Neer impingement test became negative in 60% of cases in both groups (p < 0.0001 intra-group); inter-group difference non-significant at all visits
• Hawkins test normalised in 23% of STR group (p = 0.05) and 22% of HTR group (p < 0.02); inter-group difference non-significant
• Full can test VAS improved by 2.2 in STR and 1.9 in HTR (p = 0.0001); palm-up test VAS improved by 3.0 and 2.5 respectively (p = 0.0001); no inter-group differences
• Dropout at final visit: 21 in STR and 27 in HTR (p = 0.3); mean compliance score 1.38 STR vs 1.51 HTR (p = 0.093)

Limitations

• Neither patients nor physiotherapist could be blinded to group allocation, and many patients preferred the supervised program and expressed disappointment when assigned to home training
• Patient sample was older (mean age ~61 years) and may not represent younger or more active patients who might benefit more from a comprehensive program
• Patients with severe pain who required more than one steroid injection declined participation, potentially biasing the sample toward milder cases
• The study was retrospectively registered, and recruitment took ~5 years, suggesting possible selection bias among those willing to participate

Why it matters

For patients

Patients with shoulder impingement can expect meaningful improvement from a simple home exercise routine without needing frequent clinic visits or complex supervised programs.

For clinicians

Prescribing a home-based rotator cuff and scapular exercise program is as effective as a comprehensive supervised protocol including heavy slow resistance training, and may be the pragmatic first-line choice.

For readers

This trial challenges the assumption that more intensive, heavier, or supervised shoulder rehabilitation is inherently superior to simpler home programs for subacromial impingement.