Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c3037 (Published 28 June 2010) Cite this as: BMJ 2010;340:c3037All rapid responses
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The title for this article is somewhat misleading. This has nothing
to do with the effectiveness of exercise or physiotherapists. It really
is a trial of whether injections add anything to exercise. Clearly it did
not.
Competing interests:
None declared
Competing interests: No competing interests
Nanivadekar makes a valid point.
Physiotherapy research is poorly funded so it should be no surprise
that it
features in the second division.
That said, all too often studies show that physiotherapy
interventions show little
improvement over doing nothing (or placebo) when looking at a time frame
of 6
to 12 months. What these studies fail to recognise is that physiotherapy
often
meets patient's expectations in the short term (functionally, as well as
pain
perception).
Of course chronic conditions recycle. However providing rapid relief
in the early
stages in any cycle is not to be sniffed at.
After all we don't cost the earth.
Competing interests:
None declared
Competing interests: No competing interests
I was pleased to read this report as the authors have carried
clinical research to its cradle: day-to-day practice. However, I was
disappointed to read the conclusion in the abstract. The difference
between the treatments might not have been significant at week 12, but it
was at week 1 and week 6. If early relief and return to usual activity is
a valued patient oriented outcome (PRO), as I suspect it is, the trial has
shown that steroid injection with exercise does achieve it better than
exercise alone!
Competing interests:
None declared
Competing interests: No competing interests
Devaluing the currency
Sir,
We are very concerned that for a trial with a sample size of 232 the
BMJ accepts the descriptor 'large' in the title. This suggests a
benchmark for the size of pragmatic RCTs of rehabilitation interventions.
There are a number of published and ongoing trials with two or three times
as many participants and at least one with more than 10 times this many.
Surely it is only these definitive trials powered to show small between
group differences that should be described as large?
Competing interests:
None declared
Competing interests: No competing interests