Apprehension-based Training Compared With Standard Physical Therapy for Military Personnel Following Anterior Shoulder Dislocation - a Randomized Clinical Trial
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Apprehension-based training, Standard physical therapy.
- Who it may be relevant to
- Registry conditions: Anterior Shoulder Dislocation. Basic parameters: 18 years — 39 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Israel
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Apprehension-based Training Compared With Standard Physical Therapy Among Military Personnel Following Anterior Shoulder Dislocation
Overview
The goal of this clinical trial is to determine if a new rehabilitation protocol (apprehension-based training), leads to better recovery after shoulder dislocation among military personnel. Participants will be randomly allocated to apprehension-based training or standard physical therapy. In apprehension-based training participants will train to control their shoulder under progressively more unstable conditions. Standard physical therapy will be provided based on the clinical judgment of the treating physical therapist The primary hypothesis is that participants undergoing apprehension-based training will experience a more complete recovery of function, better shoulder-related quality of life, and incur less recurrent dislocations.
Interventions
- Behavioral Apprehension-based training
This intervention is comprised of the 3 phases: Static phase - Isometric (static) exercises performed in progressively greater shoulder apprehension ("instability") provoking conditions Dynamic phase: Isotonic (dynamic) exercises using shoulder apprehension-provoking movement patterns at a gradually increasing pace of movement. Neurocognitive phase: Dynamic phase exercises are continued at a high pace with the addition of cognitive tasks ("distractions"). The intervention is guided by a physi - Behavioral Standard physical therapy
Standard physical will be provided based on the assessment and judgment of the physical therapist. Intervention may include active exercises for increased shoulder mobility, muscle strength and neuromuscular control. Intervention may also include manual therapies such as massage, soft-tissue and joint mobilizations, dry needling, and electrophysiological modalities. No more than 8 individual sessions with a physical therapist will be provided over the course of treatment with some form of a home
Primary outcome measures
- Return to preinjury level of function [Time frame: 3 months following the end of intervention]
- Western Ontario Shoulder Instability Index [Time frame: Baseline to end of intervention (10 weeks) and 1-year follow-up (62 weeks).]
- Recurrence [Time frame: One year following the end of the intervention]
- Supine moving apprehension test [Time frame: Baseline to end of intervention (10 weeks)]
Secondary outcome measures (6)
- Subjective shoulder value [Time frame: Baseline, end of intervention (10 weeks), and 1-year follow up (62 weeks)]
- Tampa scale of kinesiophobia [Time frame: Baseline, end of intervention (10 weeks), and 1-year follow-up (62 weeks)]
- Anterior apprehension test [Time frame: Baseline to end of intervention (10 weeks)]
- Shoulder internal/external rotator muscle strength [Time frame: Baseline and end of intervention (10 weeks)]
- Abdominal rollout [Time frame: Baseline and end of intervention (10 weeks)]
- Heart rate variability [Time frame: Baseline and end of intervention (10 weeks).]
Eligibility criteria
Inclusion criteria
- Age 18-39 years
- Shoulder dislocation (primary or recurrent) documented by a medical practitioner (physician, military medic)
- Positive anterior apprehension test
- Gross shoulder muscle strength 3/5 or greater
Exclusion criteria
- Previous shoulder fracture, tendon tear, or shoulder surgery
- Voluntary shoulder dislocation
- Functional (Stanmore polar III) shoulder instability
- Dislocation associated with a motor vehicle accident.
- Diagnosis of rheumatoid arthritis, cancer (current), fibromyalgia, psychiatric disease)
- Current pregnancy
- Inability to attend at least one physical therapy session every 2 weeks.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Double blind
- Primary purpose
- Treatment
Study locations
Israel · 1 center
- Israel Defense Forces Medical Corps — Be’er Ya‘aqov
Publications
- Rabin A, Noyman L, Yaakobi N, Kazum E. Apprehension-Based Training: A Novel Treatment Concept for Anterior Shoulder Dislocation - A Case Report. Int J Sports Phys Ther. 2024 Jul 1;19(7):888-897. doi: 10.26603/001c.118928. eCollection 2024. PMID 38966825
- Rabin A, Chechik O, Olds MK, Uhl TL, Kazum E, Deutsch A, Citron E, Cohen T, Dolkart O, Bibas A, Maman E. The supine moving apprehension test-Reliability and validity among healthy individuals and patients with anterior shoulder instability. Shoulder Elbow. 2024 Feb;16(1):98-105. doi: 10.1177/17585732231170197. Epub 2023 Apr 18. PMID 38435037
Identifiers
NCT: NCT06752551 · 2388-2023