Study Finds Physical Therapy As Effective, Less Expensive Than Steroids
The American Physical Therapy Association recently highlighted a study published in the August 2014 Annals of Internal Medicine. This study, the first of its kind, finds that when it comes to shoulder impingement syndrome (SIS), physical therapy and steroid injections work equally well, but physical therapy is the less costly option.
Researchers followed 104 patients with SIS who were split into 2 groups, the first group receiving up to 3 corticosteroid injections (CSIs) of 40 mg triamcinolone acetonide 1 month apart, and the second group receiving physical therapy twice weekly for 3 weeks and prescribed home exercises. Participants ranged in age from 18 to 65.
After 1 year, researchers monitored changes to Shoulder Pain and Disability scores, as well as Global Rating of Change scores, Numeric Pain Rating Scale scores, and health care use. They found that both groups reported a 50% improvement in pain and disability scores; however, patients receiving CSIs had more SIS-related visits to their primary care provider than the physical therapy group (60% vs 37%) and required additional steroid injections at a rate higher than requests for additional physical therapy in the therapy group (38% vs 20%).
Groundbreaking Research: The First of Its Kind
The research, conducted at a military hospital-based outpatient clinic, is the first to directly compare the effectiveness of 2 common nonsurgical approaches to SIS, according to the study’s authors. The study was primarily funded by Cardon Rehabilitation Products through the American Academy of Orthopaedic Manual Physical Therapists.
News of the study appeared in Reuters, Healthfinder, WebMD, and Medscape, with the latter 2 publications mentioning possible limitations in the study that include demographic differences in subgroups and the fact that cost estimates were based on a military hospital setting that required no copayments.
Physical Therapy as a First Choice
So what do the results of this study mean for patients? Because physical therapy and steroids were found to be equally effective in the study, physical therapy ought to be the first choice of treatment. Because it’s less expensive, it may be the preferred treatment option to start. Then, if physical therapy doesn’t achieve the desired results, patients could then turn to the more expensive steroids. For some, a combination of physical therapy and steroids may end up being the right choice.
Per the results of the study, patients who begin with physical therapy are less likely to return to their doctor about their pain. Patients who began with steroid shots were 60% likely to return for either more shots or for physical therapy. By contrast, those who started with physical therapy were only 37% likely to return for further treatment.