Long-term shoulder-related secondary health-care contact among people with subacromial pain: a secondary analysis of a randomized controlled trial of home-based vs. supervised exercise regimens

Background: Subacromial pain is associated with substantial individual burden and health‐care costs. Exercise rehabilitation can be delivered either at home or under physiotherapist supervision. This study investigated whether home‐based exercise rehabilitation was associated with increased long‐term secondary health‐care utilization compared with supervised exercise rehabilitation. Methods: A total of 208 participants were randomized to home‐based, group‐based, or individually supervised exercise rehabilitation. For this secondary analysis, the 2 supervised groups were pooled and compared with the home‐based group. The outcomes were shoulder‐related secondary health‐care contacts and shoulder surgery during the 5‐year follow‐up. Associations were analyzed using logistic regression and reported as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: During the 5‐year follow‐up, 22/71 participants (31%) in the home‐based group and 45/137 (33%) in the supervised group had a shoulder‐related secondary health‐care contact (adjusted OR 0.91; 95% CI 0.52–1.61). Shoulder surgery was recorded in 14/71 participants (20%) in the home‐based group and 24/137 (18%) in the supervised group (adjusted OR 1.16; 95% CI 0.42–3.22). Conclusion: In this 5‐year register‐based follow‐up of a randomized controlled trial, we found no evidence of increased shoulder‐related secondary health‐care contacts or surgery following home‐based compared with supervised exercise rehabilitation for subacromial pain. However, the estimates were imprecise and should be interpreted with caution. These findings support home‐based exercise as a potentially scalable rehabilitation strategy, although larger studies are needed to confirm long‐term health‐care utilization outcomes.