Effect of Low-Load Blood Flow Restriction Training Combined with Rotator Cuff Exercise on Pain, Strength, and Function in Adults with Rotator Cuff-Related Shoulder Pain: A Randomized Controlled Trial
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Background: Low-load blood flow restriction (BFR) training may provide a strengthening stimulus while limiting external mechanical loading, but its incremental clinical value for rotator cuff-related shoulder pain remains uncertain. Objective: To model whether adding BFR to standardized low-load rotator cuff exercise produces superior changes in shoulder disability, pain, and rotational strength compared with the same exercise programme without BFR. Methods: A-two-arm randomized trial model included 54 participant profiles allocated equally to BFR plus exercise or conventional low-load exercise. The modeled intervention comprised three supervised sessions weekly for 6 weeks, with outcomes assessed at baseline, week 3, week 6, and week 18. SPADI was the primary outcome; NPRS and external- and internal-rotation strength were secondary outcomes. Longitudinal mixed-effects models constituted the primary analytical framework, supplemented by baseline-adjusted sensitivity models and week-6 ANCOVA. Results: Both groups demonstrated substantial modeled improvement in SPADI. The prespecified SPADI group-by-time interaction was not statistically significant (χ²(3)=7.553, P=0.056), and the baseline-adjusted week-6 difference was 0.04 points (95% CI −1.58 to 1.65; P=0.963). Adjusted NPRS favored conventional exercise by 0.54 points at week 6 (95% CI 0.32 to 0.76; P<0.001). External-rotation strength showed no significant adjusted between-group difference, whereas the week-6 internal-rotation contrast favored BFR by 3.07 N (95% CI 1.03 to 5.11; P=0.004), despite a nonsignificant adjusted longitudinal interaction. Conclusion: This did not demonstrate a clinically meaningful incremental BFR benefit for shoulder disability. Conventional exercise produced a modest pain advantage, while the internal-rotation strength signal remained exploratory and requires confirmation in adequately powered prospective trials
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