Implementation of a shoulder school for rotator cuff-related shoulder pain in primary care centres in Spain: A cluster randomised controlled trial

Purpose: To compare a specific and graded exercise program (shoulder school) to the standard care protocol provided in the physiotherapy units of Spanish primary care centres to patients with rotator cuff-related shoulder pain (RCRSP). Methods: A cluster randomised controlled trial was designed. Seven primary care centres participated in the study and were randomised into the shoulder school group (SSG) or the standard care group (SCG). Eighty-seven participants with RCRSP were included (SSG: n=47; SCG: n=40). Both groups underwent 16 sessions over eight weeks. The primary outcome was shoulder pain assessed using a 0-10 VAS over the last three days and during arm elevation. Secondary outcomes were disability (SPADI and DASH), active range of motion, isometric strength, quality of life (WORC), and patient satisfaction (GROC). Outcomes were measured by blinded examiners at baseline (T0), post-intervention (T1), and after 3 months (T2). Results: Significant differences between-groups were found favouring the SSG for the primary outcome of pain intensity over the last three days at T1 (Mean difference [MD]=-2.44, 95% CI -3.18 to -1.69) and T2 (MD=-4.03, 95% CI -4.89 to -3.17), and during arm elevation at T1 (MD=-2.80, 95% CI -3.87 to -1.72) and T2 (MD=-4.03, 95% CI -5.20 to -2.85), as well as for the secondary outcomes of disability, range of motion, isometric strength, quality of life and patients' satisfaction (T1: p<0.01; T2: p<0.01). Changes in pain intensity, disability, quality of life and patient satisfaction were higher than the minimal clinically important difference at T1 and T2, favouring the SSG. Conclusion: The implementation of shoulder school in primary care physiotherapy units proved to be statistically and clinically more effective than the standard protocols in the short- and medium-term, in patients with RCRSP.