Effect of a multicomponent exercise program focused on multivariable fatigue improvement versus standard care for glenohumeral instability: MoveUS study protocol

Abstract

Background: Glenohumeral instability is a highly prevalent pathology; however, there are problems in defining it. Traditionally, structural problems such as labral injury or bone loss in the glenoid cavity and/or humeral side were considered the main causes; but recently, it has been seen that motor control plays a very relevant role. This means that currently, there is a disparity of action protocols, and the treatment of this pathology is a great challenge. Methods: A single-blind randomized controlled trial will be carried out, in which 108 adult patients who have suffered at least one episode of glenohumeral instability in the last year will be recruited by the Department of Traumatology and Rehabilitation of Axarquia Hospital (Málaga). Patients will be randomized to the intervention group, which will carry out a multicomponent therapeutic exercise program supervised by physiotherapists (MoveUS Program); or to the control group, which will receive the usual care. All subjects will be evaluated at baseline, mid-treatment, after the intervention, and three months later at the follow-up. In these evaluations, range of movement, maximum peak of isometric force, kinematic, physiological, and psychometric fatigue, return to activity, motor control, and number of recurrences will be assessed; as well as the quality of life measured through the Western Ontario Shoulder Instability Index, which will be the main outcome variable. Discussion: This study aims to determine if therapeutic exercise supervised by physiotherapists is capable of reducing multivariable fatigue, reducing the number of recurrences, and improving quality of life; to be able to implement it in the future in public and private clinics since materials are available and physiotherapist have enough skills in the field of therapeutic exercise, so it is expected to be a quality tool in the approach to glenohumeral instability.