Implementation of Shoulder School in Albania

Shoulder pain is a common musculoskeletal condition that can cause pain, movement limitations, disability, and difficulties performing daily and occupational activities. Rotator cuff-related shoulder pain (RCRSP) is one of the most common clinical presentations among people seeking care for shoulder problems. Exercise therapy is recommended as a first-line conservative treatment for RCRSP. Progressive resistance training and motor control exercises can improve pain and shoulder function, while exercises targeting thoracic mobility and scapular and glenohumeral function may be useful for addressing individual movement and functional limitations. However, there is still uncertainty about the optimal selection, intensity, volume, and progression of exercises for individual patients. Objective To analyze the effects of a shoulder school program led by a physiotherapist and based on therapeutic exercise focused on active scapular and thoracic work, compared to conventional treatment in patients with RCRSP referred to Primary Care Physiotherapy Units in Albania, regarding pain, functional capacity, and quality of life. Methods Design: Single-blind, multicenter, prospective, randomized, controlled non-inferiority study. Sample: Patients with RCRSP referred to primary care in Albania. Dependent Variables: Pain, functional capacity, quality of life, joint mobility, isometrical strenght, and patient satisfaction. Independent Variables: Intervention group: Shoulder school program including exercises focused on scapular, thoracic, and rotator cuff function. Control group: Conventional physiotherapy treatment. Randomization: Cluster randomization by centers. Analysis: Data will be analyzed using SPSS version 25.0. Clinical Implications This study will provide objective data on the effects of implementing a group exercise program guided by a physiotherapist. The results could offer evidence for a resource that may be highly useful in Primary Care Physiotherapy. This approach has the potential to optimize labor, time, and space resources within this healthcare service.

Inclusion Criteria: * 1)aged over 18 years; 2) shoulder pain lasting more than six weeks; 3) shoulder pain attributable to rotator cuff tendinopathy or tendinosis, bursitis or impingement, according to the diagnostic criteria of the most recent clinical guidelines, international consensus * and the British Shoulder and Elbow Society; and 4) ability to understand and complete the evaluation questionnaires. Exclusion Criteria: * 1\) presence of red-flag symptoms suggesting fractures, dislocations, or complete tendon tears, among others; 2) neurological disorders; 3) other severe shoulder pathologies such as inflammatory arthritis, frozen shoulder, or glenohumeral instability; 4) corticosteroid injections or physical therapy treatment within the last six months; 5) prior shoulder surgery; 6) pregnancy; 7) or cognitive deficits that could limit comprehension of questionnaires or participation in testing.