CHAPITRE 2. MÉTHODOLOGIE
4.5 Implications cliniques
Les résultats de notre étude suggèrent qu’en comparaison avec des personnes présentant des caractéristiques similaires, les participants souffrant de tendinopathie ne présentent pas nécessairement une diminution de la DAH lors de l’élévation du membre supérieur. Ainsi, les cliniciens ne devraient pas rechercher ce déficit à tous prix, ni chercher à le normaliser d’emblée, puisqu'il n’est pas nécessairement la cause des symptômes douloureux. Toutefois, les résultats suggèrent que les personnes souffrant de tendinopathie, qu’elles présentent une diminution de la DAH ou non, bénéficient d’une intervention en physiothérapie axée sur
l’entrainement au mouvement. L’entrainement au mouvement est donc une approche à privilégier auprès des sujets souffrant de tendinopathie
Il a été relevé plus tôt que les personnes souffrant de tendinopathie de la coiffe des rotateurs utilisent une multitude de stratégies motrices et présentent des déficits moteurs qui diffèrent entre les individus. Ce constat démontre l’importance d’évaluer individuellement la qualité du mouvement de l’épaule afin de déterminer, lors de l’évaluation par le professionnel de la santé, les déficits propres à ces personnes. Dans ce contexte, il est possible d’émettre l’hypothèse que le choix des interventions devrait être ajusté selon les déficits observés. Dans cette étude, il était justement demandé aux physiothérapeutes traitants de personnaliser, selon les déficits notés et à l’aide de consignes standardisées, l’intervention en ce qui concerne l’entrainement moteur, le choix des exercices thérapeutiques et les interventions en thérapie manuelle. À la suite de cette intervention qui ciblait les déficits observés, les résultats obtenus ont été fort intéressants. Puisque les résultats semblent supérieurs à certaines études précédentes, on pourrait donc émettre l’hypothèse qu’en personnalisant l’intervention selon les déficits observés, on optimise les gains. Cela reste toutefois à être démontré à l’aide d’études de plus hauts niveaux d’évidence (un essai clinique randomisé, par exemple).
CHAPITRE 5. CONCLUSION
Le projet de maîtrise permet d’améliorer les connaissances scientifiques en lien avec les personnes souffrant de tendinopathie de la coiffe des rotateurs. En effet, cette étude pré- expérimentale a été la première à suivre l’évolution de la DAH à la suite d’une intervention en physiothérapie. De plus, cette étude présente la plus grande cohorte de participants souffrant de tendinopathie de la coiffe à avoir participé à un entrainement au mouvement. Les résultats ont démontré que les participants souffrant de tendinopathie de la coiffe ont présenté des améliorations significatives des niveaux de douleur et du niveau fonctionnel à la suite d’une intervention en physiothérapie axée sur l’entrainement au mouvement. De plus, une augmentation significative de la DAH lors de l’élévation du membre supérieur a été notée après l’intervention.
Parmi les participants, un sous-groupe présentait une diminution plus marquée de la DAH lors de l’élévation du membre supérieur. Ce sous-groupe a présenté une amélioration significativement plus importante de la DAH que les autres participants qui ne présentaient pas une diminution marquée de la DAH. Toutefois, bien que les changements au niveau de la DAH étaient différents, les deux groupes ont présenté une amélioration semblable des niveaux de douleurs et des niveaux fonctionnels : les deux sous-groupes ont présenté une amélioration statistiquement et cliniquement significative de leur condition.
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