Proprioceptive Exercises Combined With Strengthening Exercises Are Not Superior to Strengthening Exercises Alone for Shoulder Pain and Disability in Individuals With Chronic Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial

OBJECTIVE: To compare the effect of combining proprioceptive exercises with strengthening exercises versus strengthening exercises alone, on shoulder pain and disability in individuals with chronic rotator cuff-related shoulder pain (RCRSP). DESIGN: Parallel group randomized controlled trial. METHODS: Seventy individuals with chronic RCRSP were randomly assigned to either the control group (n=35; muscle strengthening exercises) or the experimental group (n=35; muscle strengthening combined with proprioceptive exercises) for a 2-month program of supervised and home-based exercises. The primary outcome, the Shoulder Pain and Disability Index (SPADI), was assessed at baseline, 2 and 5 months, while the secondary outcomes: pain intensity, proprioception, isokinetic muscle strength, catastrophizing, kinesiophobia and self-efficacy, were evaluated at baseline and 2 months. A linear mixed model was used for statistical analysis. RESULTS: There was no significant group-by-time interaction for the SPADI (p=0.25). Significant time effects, but no between-group differences, were found for improvements in pain intensity, kinesiophobia, catastrophizing, self-efficacy, kinesthesia, and joint position sense, while a decline in lateral rotator peak torque was noted. CONCLUSION: Combining proprioceptive with shoulder strengthening exercises did not lead to additional improvements across all outcomes in individuals with chronic RCRSP. The lack of a non-intervention group limits the ability to determine whether the improvements in both groups were due to the exercise programs or to natural recovery.