Participants
Between March 2004 and November 2007, we recruited people with chronic rotator cuff disease through medical practitioners and from the community through print and radio media.
We required all participants to have a plain radiograph of the shoulder to check for exclusions (see below), and we required potential participants recruited directly from the community to have the diagnosis of rotator cuff disease
confirmed by a medical practitioner.
After an initial screen by telephone, an experienced physiotherapist (EW or SC) did a physical examination. Inclusion criteria were age over 18 years, shoulder pain for more than three months, severity of pain on movement rated
greater than 3/10 on an 0-10 numerical rating scale, pain on active abduction or external rotation, and a positive quick test for shoulder impingement.24 Exclusion criteria were resting severity of shoulder pain greater than 7/10; reason to suspect a complete rotator cuff tear (for example, substantial shoulder weakness, a positive drop-arm sign, or a high riding humerus on plain radiograph); previous shoulder surgery; radiological evidence of shoulder osteoarthritis, calcification, or previous fracture; systemic pathology including inflammatory joint disease or neoplastic disorders; more than 50% restriction of passive range of motion in two or more planes; shoulder pain referred from vertebral structures diagnosed by spinal clearing tests25; symptoms of complex regional pain syndrome; active intervention in the previous three months, Shoulder disorders can thus lead to considerable disability, reduced health related quality of life, absenteeism from work, and use of healthcare resources