Table 2

Description of tailored rehabilitation intervention, as per the template for intervention description and replication (TIDieR) guide

Item numberItemDescription
1. BRIEF NAME
Tailored rehabilitation
2. WHY Describe any rationale, theory or goal of the elements essential to the intervention.The tailored rehabilitation programme will focus on specific impairments presented by the patient. This intervention will consist of mobilisation with movement, passive accessory mobilisation, specific motor control exercises and specific muscle strengthening exercises. The tailored rehabilitation programme might be more effective than a standardised strengthening programme for patients with subacromial shoulder pain.
3. WHAT
Materials: Describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers. Provide information on where the materials can be accessed (eg, online appendix, URL).
The tailored rehabilitation group will receive manual therapy techniques (including mobilisation with movement with taping),70 95 motor control and strengthening exercises. Manual therapy interventions delivered by the clinician might be performed with a belt. Motor control and strengthening exercises might be performed with the use of elastic bands or dumbbells. Home-based exercises will consist of self-mobilisation techniques that is performed with a belt. Detailed information is described on online supplementary file 1.
4.Procedures: Describe each of the procedures, activities and/or processes used in the intervention, including any enabling or support activities.Clinicians will choose exercises based on physical impairments presented during the physical assessment.
5. WHO PROVIDED
For each category of intervention provider (eg, psychologist, nursing assistant), describe their expertise, background and any specific training given.
Experienced clinicians will deliver interventions for the tailored group. Clinicians will have a postgraduate diploma in musculoskeletal rehabilitation (or related field) and a minimum of 5 years of clinical experience. All clinicians will undergo a trial-specific training programme to ensure they understand the protocol and the rationale of the intervention. Clinicians will receive a detailed manual with information regarding the trial intervention.
6. HOW
Describe the modes of delivery (eg, face-to-face or by some other mechanism, such as internet or telephone) of the intervention and whether it was provided individually or in a group.
Participants will receive individual, face-to-face sessions.
7. WHERE
Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features.
Interventions will be delivered in a private clinical practice.
8. WHEN and HOW MUCH
Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule and their duration, intensity or dose.
Participants will receive 16 sessions, each lasting for a maximum of 60 min, twice per week, over an 8-week period.
The exercise programme will comprise eight exercises plus three optional manual therapy techniques (one for the cervical spine, one for the thoracic spine and one for the shoulder). Clinicians will decide on which technique to use based on participants’ clinical presentation. The manual therapy techniques might consist of passive joint mobilisations (grade −IV, IV or +IV) or manipulation (for the cervical or thoracic spine).
Mobilisation with movement techniques will count as one of the 8 possible exercises to be performed within a session. This technique will be performed with 3 sets of 10 repetitions, with 30 s of rest between each set.
Passive joint mobilisations will be performed with the following dosage: 3 sets, 30 s duration. Grade: –III or –IV will be performed if pain is dominant (as per physical assessment) or grade +III or +IV if stiffness dominant (as per physical assessment).
Joint manipulation will be performed once per session, if required, as per physical assessment. The clinician will have the freedom to decide which technique to perform.
Isometric exercises will be delivered with the following dosage: 2 sets, 10 repetitions, with 10 s hold each repetition. The isometric exercises will be progressed in two stages. The first stage will have the following dosage: 3 sets, 10 repetitions, with 10 s hold each repetition. The second stage will have the following dosage: 3 sets, 10 repetitions, with 20 s hold each repetition. There will be 10 s rest between repetitions, and 30 s rest between sets.
Dynamic strengthening exercises will be delivered with the following dosage: 2 sets of 10 repetitions. The dynamic strengthening exercises will be progressed in two stages. The first stage will have the following dosage: 3 sets of 10 repetitions. The second stage will have the following dosage: 3 sets of 20 repetitions.
All exercises should initially be performed in slow and controlled pace. All motor control exercise should initially be of low intensity and then progressed as described. Clinicians can increase dosage (repetitions, sets, or load) if the participant is able to perform low intensity exercise for two consecutive sessions.
The load for strengthening exercises will be determined through using the 10-point Rate of Perceived Exertion (RPE) scale, considering the affected side. Low intensity will be defined as 3–4 RPE, moderate intensity as 5–6 RPE, and high intensity as 7–8 RPE.Exercises will start with low intensity, and can progress to moderate and high intensity during the course of treatment.
9. TAILORING
If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when and how.
Interventions will be tailored based on physical assessment.
Participants will receive:
  • Shoulder mobilisation with movement if, during assessment, participants improve range of motion and pain with the mobilization with movement (MWM) technique. As part of the treatment, clinicians might use an MWM taping technique.70 95

  • Passive mobilisation on the cervical, thoracic spine or shoulder (glenohumeral joint). These techniques will be performed if, during assessment, participants present with stiffness or pain on passive accessory movement at the cervical, thoracic spine or glenohumeral joint.

  • Motor control exercises if, during assessment, participants present with poor control of a specific muscle (eg, scapular control exercises, dynamic control of glenohumeral joint).40 96–98

  • Strengthening exercises if, during assessment, participants present with muscle weakness.40

10. MODIFICATIONS
If the intervention was modified during the course of the study, describe the changes (what, why, when and how).
Not applicable. This is a protocol.
11. HOW WELL
Planned: If intervention adherence or fidelity was assessed, describe how and by whom and if any strategies were used to maintain or improve fidelity, describe them.
Participants’ adherence to protocol will be assessed by quantifying the number of home-based exercises performed. It will be expressed as percentage of the total number of sessions that should be been performed.
Clinician's adherence to protocol will be assessed by quantifying the number of exercises and progressions that were performed according to the protocol. This will be done through audits of clinical notes, and will be expressed as percentage of the total number of exercises and progressions that were performed during the course of treatment.
12.Actual: If intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned.Not applicable. This is a protocol.