Enhancing adherence and outcomes in rotator cuff-related shoulder pain: A randomized trial of individualized exercise sequencing

Abstract

Background

Adherence to exercise remains a challenge in rotator cuff-related shoulder pain (RCRSP).

Objective

This study compared an individualized exercise sequence with a content-matched random sequence on pain, disability, and adherence in adults with chronic RCRSP.

Methods

In a single-center randomized controlled trial, 55 participants with chronic RCRSP were assigned to an individualized, algorithm-based sequencing protocol or to a random sequence of the same 13 home-based exercises (24 sessions over four weeks). The primary outcome was the Shoulder Pain and Disability Index (SPADI) total score at eight weeks. Secondary outcomes included pain intensity, the Korean version of the Disabilities of the Arm, Shoulder and Hand questionnaire (K-DASH), and range of motion. Adherence, defined as completed cycles, was a key measure.

Results

Forty-eight participants (87.3%) completed the eight-week follow-up. Group baseline characteristics were similar. Intervention fidelity was confirmed, with distinct sequencing patterns between groups (p < 0.05). Adherence was higher in the individualized group (media4.0 cycles) than in the random sequencing group (median 1.0 cycle; p < 0.001). This difference corresponded to greater improvement in the primary outcome and all secondary outcomes across follow-ups (all post hoc p < 0.001). Linear mixed-effects models also showed a steeper rate of functional improvement (K-DASH and range of motion) in the individualized group.

Conclusion

Individualized sequencing was associated with superior adherence and improved outcomes. Interpretation requires caution: the large treatment effect was likely mediated by adherence, and the low compliance in the random sequencing group may not reflect usual practice.