Physiotherapist Supervised Training in Patients With Anterior Shoulder Instability (ASIST)
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ClinicalTrials.gov Identifier: NCT06033157 |
Recruitment Status :
Recruiting
First Posted : September 13, 2023
Last Update Posted : December 8, 2023
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The goal of this clinical trial is to investigate if physiotherapist supervised training improves neuromuscular control in patients suffering from traumatic anterior shoulder instability. The main question(s) it aims to answer are:
- Does physiotherapist supervised training improve shoulder neuromuscular control
- Does physiotherapist supervised training prevent recurring shoulder dislocations
- Is physiotherapist supervised training as good as surgery in improving shoulder neuromuscular control Participants will be randomised to either a training group or a no-training group.
Participants in the training group will undergo a 12 week training-program supervised by a physiotherapist.
Participants in the no-training group will receive a consultation with a shoulder surgeon, where information and general advice regarding the shoulder injury is provided.
Researchers will compare the training group to the no-training group to see if physiotherapist supervised training improves shoulder neuromuscular control in patients with traumatic anterior shoulder instability. The training group will also be compared to a historic group of patients with traumatic anterior shoulder instability, who underwent arthroscopic surgery.
Condition or disease | Intervention/treatment | Phase |
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Shoulder Instability Subluxation Bilateral | Behavioral: Physiotherapist supervised training | Not Applicable |
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Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 64 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Double (Investigator, Outcomes Assessor) |
Primary Purpose: | Treatment |
Official Title: | The Effect of Physiotherapist Supervised Training on Neuromuscular Control in Patients With Traumatic Anterior Shoulder Instability |
Actual Study Start Date : | November 7, 2023 |
Estimated Primary Completion Date : | September 2025 |
Estimated Study Completion Date : | March 2027 |
Arm | Intervention/treatment |
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Active Comparator: Training
A 12 week physiotherapist supervised training program
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Behavioral: Physiotherapist supervised training
A 12 week physiotherapist supervised training program. The patient will receive supervision by a physiotherapist 6 times during the intervention period. The patient is strongly encouraged to do the assigned training protocol at home 3 times a week. The supervised physiotherapy consists of introduction, review and progression of the assigned exercises. In addition, the patient will receive education and guidance in daily use of the arm and appropriate load on the shoulder. |
No Intervention: No-training
A short consultation with a designated orthopedic surgeon and a folder with general advice on how to avoid further dislocations and to relieve pain from the shoulder.
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- Neuromuscular control - Shouldersway [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]- Shoulder sway. Measured as sway-length (in millimeter).
- Clinical examination - Shoulder instability [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]- Shoulder instability tests: Sulcus sign, load and shift, apprehension test, relocation test.
- Clinical examination - Shoulder range of motion [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]- Shoulder range of motion in flexion, extension, abduction, internal and external rotation
- Strength measure [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]Shoulder internal rotational strength, measured in Newton.
- Apprehension measure [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]An assessment (in degree) of when during an external rotational movement, the patient feels apprehension.
- Patient-reported outcome measures [ Time Frame: Will be tested prior to intervention and 3, 6, 12 and 24 months after the beginning of the intervention ]
- WOSI-score
- Purpose-made questions about return to sport and work, and fear of reinjury.
- Redislocations [ Time Frame: Will be tested 3, 6, 12 and 24 months after the beginning of the intervention ]Patients will be asked on every visit, if they have sustained re-dislocation of their shoulder
- Neuromuscular control - Joint Position Sense [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]- Joint position sense for shoulder external rotation. Repositioning error is measured in degree.
- Neuromuscular control - Reaction Time [ Time Frame: Will be tested prior to intervention and 3 and 6 months after the beginning of the intervention ]- Reaction time. Measured as the time (in milliseconds) it takes the patient to respond to a sudden movement in the shoulder joint.
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Ages Eligible for Study: | 18 Years to 40 Years (Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age 18-40 years.
- Unilateral traumatic anterior shoulder instability.
- Willingness to adhere to the study protocol, herein attend follow-up.
- Ability to speak, read, and understand Danish.
- Ability to give written informed consent.
Exclusion Criteria:
- Instability in the opposite shoulder.
- Off-track lesion.
- For both shoulders: Former or planned surgery.
- For both shoulders: posterior, multi-directional or atraumatic instability.
- For both shoulders: traumatic rotator cuff or biceps tendon tear.
- For both shoulders: traumatic fracture of proximal humerus (other than Hill-Sachs lesion), clavicula, scapula (other than glenoid) or dislocation of sternoclavicular or acromioclavicular joints.
- For both shoulders: atraumatic shoulder pathologies (e.g. frozen shoulder, symptomatic osteoarthritis of the shoulder or acromioclavicular joints, acute tendinitis calcarean).
- Pregnancy.
- Terminal illness or severe medical illness: ASA score ≥3.
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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06033157
Contact: Kristine R Andreasen, MD | +45 30604373 | kristine.rask.andreasen.01@regionh.dk | |
Contact: Kristoffer W Barfod, MD, PhD | kbarfod@dadlnet.dk |
Denmark | |
Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre | Recruiting |
Hvidovre, Capital Region, Denmark, 2650 | |
Contact: Kristine R Andreasen, MD +4530604373 kristine.rask.andreasen.01@hotmail.com |
Principal Investigator: | Kristine R Andreasen, MD | Copenhagen University Hospital, Hvidovre | |
Study Chair: | Kristoffer W Barfod, MD, PhD | Copenhagen University Hospital, Hvidovre | |
Study Director: | Kristoffer W Barfod, MD, PhD | Copenhagen University Hospital, Hvidovre |
Responsible Party: | Kristine Rask Andreasen, MD, Hvidovre University Hospital |
ClinicalTrials.gov Identifier: | NCT06033157 |
Other Study ID Numbers: |
ASIST-1 |
First Posted: | September 13, 2023 Key Record Dates |
Last Update Posted: | December 8, 2023 |
Last Verified: | December 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Joint Instability Joint Diseases Musculoskeletal Diseases |