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Adherence to Exercise Intervention Including Pain Threshold, Exercise and Physiotherapy Sessions for Patients With
Sebastian Åxman1, Rene Brüggebusch Svensson2, Camilla Cullum1
1Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Department of Orthopaedic Surgery, Institute of Sports Medicine, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen.
Objectives:
To investigate adherence to 2 pain threshold protocols during a 26-week exercise intervention for chronic rotator cuff tendinopathy. The main objective was to evaluate adherence to pain thresholds defined as maintaining a consistent difference in pain levels between groups; secondary objectives included adherence to exercise and physiotherapy sessions.
Design:
Secondary data on adherence to the intervention in a randomized controlled trial with a 1-year follow-up.
Setting:
Outpatient clinic in a secondary care setting.
Participants:
Eighty-four patients (N=84) diagnosed with chronic rotator cuff tendinopathy who were enrolled in the randomized controlled trial, the Pain during Shoulder Exercise trial. Inclusion required shoulder pain for >3 months and a clinical diagnosis of supraspinatus and/or infraspinatus tendinopathy verified by ultrasound.
Interventions:
Participants were assigned to 1 of 2 protocols: exercising with pain allowed up to 5 on the Numeric Pain Rating Scale (PAllow), or exercising below 3 pain (PAvoid). Both groups followed a standardized physiotherapy program and completed pain and exercise logbooks.
Main Outcome Measures:
Adherence to assigned pain thresholds, logbook completion (pain and exercise), and physiotherapy attendance.
Results:
Mean exercise pain was 2.8 (SD ±0.21) in PAllow and 1.6 (SD ±0.19) in PAvoid (p<.001), confirming adherence to protocols. Pain logbook adherence declined from 76% to 68%; exercise logbook from 75% to 61%, with no group difference (p=.847). Seventy-five percent of participants attended ≥6 of 8 physiotherapy sessions; no group difference was observed (p=.726). A drop in logbook adherence after week 20 may relate to the final physiotherapy session occurring that week.
Conclusions:
Participants adhered to their assigned pain thresholds. Adherence to exercise and physiotherapy was good across groups, though logbook use declined over time, particularly after supervision ended.
