An interventional study of Sensorimotor training with movement representation techniques in Rotator Cuff Related Shoulder Pain, sponsored by The Hong Kong Polytechnic University. Recruiting at 1 site in Hong Kong. Open to participants aged 50 Years and older. Per ClinicalTrials.gov, last updated 2026-09-17.
Sponsored by The Hong Kong Polytechnic University · Not applicable, Interventional, and Treatment
The aim of this study is to evaluate the efficacy of 12 weeks of sensorimotor training with movement representation techniques for reducing pain intensity in people with rotator cuff related shoulder pain, relative to standard care. Besides, the secondary aim of this study is to explore the mechanisms underlying the effects of central mechanism treatment in people with rotator cuff related shoulder pain. A total of 122 older adults aged 50 or above with the presence of shoulder pain for more than three months will be recruited and randomized into 12-weeks of movement representation techniques with sensorimotor training vs. standard care. Shoulder pain and disability Index (SPADI), changes in primary motor cortex (M1) using brain MRI, changes in subacromial space using ultrasound imaging, Widespread Pain Index (WPI), Pain Catastrophising Scale (PCS), and Fear-avoidance Beliefs questionnaires (FABQ) will be assessed at baseline and 12-week post intervention.
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Exclusion Criteria:
Wait-list control
Other: Sensorimotor training with movement representation techniques
Sensorimotor training will be implemented with movement representation techniques using a standardized retraining sequence of a shoulder control exercise during arm elevation with 3 phases: Phase 1: Action Observation Training; Phase 2: Mirror therapy; and Phase 3: Sensorimotor training of the involved arm. Each session will last 60 minutes, with one supervised intervention session over the 12 weeks.
Pain intensity
Pain will be assessed using the pain sub-score of the Chinese Version of the Shoulder Pain and Disability Index. It is a validated self-administered questionnaire used to evaluate upper limb symptoms and functional limitations during daily activities. The questionnaire consists of 13 items with two subscales, i.e., pain intensity (five items) and disability (eight items), and each subscale-item will be summed to obtain a pain-score and a disability-score. The total of all items will be summed to obtain the final scores for each domain ranging from 0 to 100, with higher scores indicating more pain and disability. In the present study, the pain sub-score will be used as the measure of average pain intensity.
Time frame: Baseline and 12-weeks post-intervention
Cortical thickness in the primary motor cortex (M1) using brain MRI
The brain structure will be measured using structural and resting-state functional magnetic resonance imaging (fMRI) on a 3.0 T Siemens Prisma scanner. During the resting-state scan, the participants will be instructed to rest with their eyes closed while remaining stationary for 30 minutes. The regional cortical thickness of the brain region, the primary motor cortex (M1), will be extracted from T1-weighted MRI images.
Time frame: Baseline and 12 weeks post-intervention
Shoulder strength
The isokinetic testing of shoulder rotational strength will be measured using a Cybex Norm isokinetic dynamometer
Time frame: Baseline and 12-weeks post-intervention
Subacromial space
The subacromial space will be scanned using an ultrasound scanning system during arm resting at 0° and static arm holding at 60° of shoulder abduction. The subacromial space will be measured from the tangential distance between the humeral head and the infero-lateral edge of the acromion. Three measurements will be recorded and the averaged value will be calculated.
Time frame: Baseline and 12-weeks post-intervention
Central pain processing
The Widespread Pain Index will be adopted to capture features of central sensitisation. It quantifies the extent of bodily pain on a 0-19 scale, assessing whether patients have pain in 19 different body regions, each point scores 1. All items will be summed to obtain a final score ranging from 0 to 100, with higher scores indicating more widespread pain.
Time frame: Baseline and 12-weeks post-intervention
Pain Catastrophising
The Chinese version of the Pain Catastrophising Scale will be used to assess pain catastrophising. This is a validated self-administered questionnaire consisting of 13-items examining pain-related behaviours and cognition. Scores range from 0 to 52, with higher scores indicating a higher level of catastrophising.
Time frame: Baseline and 12-weeks post-intervention
Fear-avoidance Beliefs questionnaires
The Chinese version of the Fear-avoidance Beliefs questionnaires is a self-administered questionnaire consisting of 16 items with 2 subscales that evaluate fear avoidance beliefs about physical activity and work. Each item is scored from 0 to 6, representing completely disagree to completely agree. The total score is calculated by the summation of the individual scores of each item, from 0 to 96, with higher scores indicating a higher degree of fear avoidance belief.
Time frame: Baseline and 12-weeks post-intervention
Plan to share: Undecided
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The Hong Kong Polytechnic University