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Bardsley JL, Daw RLC, Gibson J, Brownson P, Guisasola I, Kent M, Parmar R, Smith MG. Physiotherapy treatment for reverse total shoulder arthroplasty: Results of a patient-centred rehabilitation guideline using functional and patient-reported outcome measures. Shoulder Elbow 2024; 16:330-335. [PMID: 38818106 PMCID: PMC11135195 DOI: 10.1177/17585732221133532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/13/2022] [Accepted: 09/24/2022] [Indexed: 06/01/2024]
Abstract
Rehabilitation after primary reverse total shoulder arthroplasty (RTSA) is accepted to be an essential component to successful outcome achievement, but successful rehabilitation approaches have yet to be well described in the literature. This retrospective review documents the outcomes of a cohort of 29 patients undergoing RTSA surgery with rehabilitation following the Upper Limb Treatment and Rehabilitation Advice (ULTRA) guideline (Appendix 1). The Oxford Shoulder Score, Quick Disabilities of the Arm, Shoulder and Hand score, range of movement (degrees of flexion, abduction and external rotation) and numerical rating score for pain were prospectively collected pre-operatively and at one- and two-years post-operatively. Scores were then evaluated to establish whether or not there were any significant changes over time. Statistically significant improvements were seen in all outcome domains from pre-operative to one-year post-operative. All improvements met the threshold for achieving substantial clinical benefit as well as exceeding the minimum clinically important difference, and all improvements were maintained at the two-year post-operative time point. The present study showed that following the ULTRA guideline after elective RTSA can give statistically significant improvements in range of movement, pain score and patient-reported outcome at one-year post-operatively, which can be maintained up to two-years post-operatively.
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Affiliation(s)
- Jenna L Bardsley
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Rachael LC Daw
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Jo Gibson
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Peter Brownson
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Inigo Guisasola
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Matthew Kent
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Rishee Parmar
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
| | - Matthew G Smith
- Liverpool Upper Limb Unit, Department of Orthopaedics, Broadgreen Hospital, Liverpool University NHS Foundation Trust,
Liverpool, UK
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Sachinis NP, Yiannakopoulos CK, Berthold DP, Franz A, Beitzel K. Can we accelerate rehabilitation following reverse shoulder arthroplasty? A systematic review. Shoulder Elbow 2024; 16:214-227. [PMID: 38655406 PMCID: PMC11034463 DOI: 10.1177/17585732221144007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 04/26/2024]
Abstract
Background There is no consensus concerning the rehabilitation protocol following reverse shoulder arthroplasty. Several patients are expecting to be able to use their arms for sports or recreation shortly after their operation. Methods This review was designed as an intervention systematic review with narrative analysis. Authors searched English literature in PubMed and Embase databases from 1/1/1989 until July 2022. Controlled studies comparing rehabilitation protocols for patients undergoing reverse shoulder arthroplasty were included. Data quality was examined with the Cochrane risk of a bias assessment tool for randomized trials, the Methodological Index for Non-Randomized studies (MINORS) tool, as well as the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach. Results Three studies were finally analyzed. At 3 months post-op, forward flexion was found to be significantly higher in the early rehabilitation group (140.5, 95% confidence intervals (CIs): 135.10-145.89; the delayed rehabilitation group mean was 131.24, 95% CI: 125.73-136.74; p = 0.019). Twelve months post-op, no significant difference in any clinical or patient-reported outcome was shown. More complications were reported in the 6 weeks-delayed rehabilitation group. Discussion Newer regimes permit immediate shoulder mobilization but may not be applied to every patient. The lack of strong evidence warrants the need for future controlled studies; subsequently, postoperative rehabilitation should be individualized.
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Affiliation(s)
- Nikolaos Platon Sachinis
- First Orthopaedic Department of Aristotle University of Thessaloniki, “Georgios Papanikolaou” Hospital, Thessaloniki, Greece
| | - Christos K Yiannakopoulos
- IASO Hospital, Athens, Greece
- School of Physical Education and Sports Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Alexander Franz
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Knut Beitzel
- Shoulder Institute, ATOS Orthoparc Klinik, Cologne, Germany
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Optimizing Outcomes After Reverse Total Shoulder Arthroplasty: Rehabilitation, Expected Outcomes, and Maximizing Return to Activities. Curr Rev Musculoskelet Med 2023; 16:145-153. [PMID: 36867393 PMCID: PMC10043097 DOI: 10.1007/s12178-023-09823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Given the touted clinical and patient-reported outcomes of reverse shoulder arthroplasty (RTSA) in improving pain and restoring function, shoulder surgeons are rapidly expanding the indications and utilization of RTSA. Despite its increasing use, the ideal post-operative management ensuring the best patient outcomes is still debated. This review synthesizes the current literature regarding the impact of post-operative immobilization and rehabilitation on clinical outcomes following RTSA including return to sport. RECENT FINDINGS Literature regarding the various facets of post-operative rehabilitation is heterogeneous in both methodology and quality. While most surgeons recommend 4-6 weeks of immobilization post-operatively, two recent prospective studies have shown that early motion following RTSA is both safe and effective with low complication rates and significant improvements in patient-reported outcome scores. Furthermore, no studies currently exist assessing the use of home-based therapy following RTSA. However, there is an ongoing prospective, randomized control trial assessing patient-reported and clinical outcomes which will help shed light on the clinical and economic value of home therapy. Finally, surgeons have varying opinions regarding return to higher level activities following RTSA. Despite no clear consensus, there is growing evidence that elderly patients are able to return to sport (e.g., golf, tennis) safely, though caution must be taken with younger or more high-functioning patients. While post-operative rehabilitation is believed to be essential to maximize outcomes following RTSA, there is a paucity of high-quality evidence that guides current rehabilitation protocols. There is no consensus regarding type of immobilization, timing of rehabilitation, or need for formal therapist-directed rehabilitation versus physician-guided home exercise. Additionally, surgeons have varied opinions regarding return to higher level activities and sports following RTSA. There is burgeoning evidence that elderly patients can return to sport safely, though caution must be taken with younger patients. Further research is needed to clarify the optimal rehabilitation protocols and return to sport guidelines.
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Rehabilitation and Return to Work and Sport After Rotator Cuff. Clin Sports Med 2023; 42:175-184. [DOI: 10.1016/j.csm.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vocelle AR, Weidig G, Bush TR. Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies. J Hand Ther 2022; 35:377-387. [PMID: 35918274 DOI: 10.1016/j.jht.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Invited review. BACKGROUND Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.
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Affiliation(s)
- Amber R Vocelle
- Physical Medicine and Rehabilitation Department, E.W. Sparrow Hospital, Lansing, MI, USA; Physical Medicine and Rehabilitation Department, Michigan State University, East Lansing, MI, USA
| | - Garrett Weidig
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA
| | - Tamara R Bush
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA.
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Claes A, Mertens MG, Verborgt O, Baert I, Struyf F. Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review. Clin Rehabil 2022; 36:1369-1399. [PMID: 35698750 DOI: 10.1177/02692155221106627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize factors that are associated with a better treatment outcome after post-operative physical therapy in patients with shoulder arthroplasty. DATA SOURCES PubMed, Cochrane, and Web of Science. REVIEW METHODS Studies examining factors that are associated with a better outcome after post-operative physical therapy interventions in patients with shoulder arthroplasty were included. Two independent reviewers performed screening, extracted data, and assessed the risk of bias and level of evidence, using the Quality In Prognosis Studies tool and Evidence-Based Guideline Development checklist. PRISMA guidelines were followed. RESULTS In total, 460 articles were found and 14 studies were included. Two of the included articles had a moderate risk of bias, 12 high. The overall number of patients in the included studies varied from 20 to 2053. Patients had either a reverse (N = 1863), an anatomic total shoulder arthroplasty (N = 1029) or, a hemiarthroplasty (N = 133). Anatomic total shoulder arthroplasty patients with a neutral rotation sling position showed less night pain and greater range of motion, which was awarded moderate evidence. Other modifiable and non-modifiable factors such as telemedicine, immediate range of motion exercises, and pre-operative function were only awarded preliminary or conflicting evidence. CONCLUSION Mainly preliminary and conflicting evidence was found. The possible causes of the conflicting evidence were the different measurement methods, implant types, and follow-up times used. The methodological quality was low and physical therapy protocols differed greatly. More high-quality research with standardized protocols is needed to determine the association of various factors with treatment outcomes after post-operative physical therapy in patients with shoulder arthroplasty.
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Affiliation(s)
- Anke Claes
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Michel Gcam Mertens
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Olivier Verborgt
- Department of Orthopaedic Surgery and Traumatology, University of Antwerp, Wilrijk, Belgium.,Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium.,MORE Foundation, Antwerp Orthopedic Center, 158103AZ Monica, Deurne, Belgium
| | - Isabel Baert
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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Moffatt M, Whelan G, Gill P, Mazuquin B, Edwards P, Peach C, Davies R, Morgan M, Littlewood C. Effectiveness of early versus delayed rehabilitation following total shoulder replacement: A systematic review. Clin Rehabil 2021; 36:190-203. [PMID: 34723708 PMCID: PMC8807994 DOI: 10.1177/02692155211044137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To investigate the effectiveness of early versus delayed rehabilitation following total shoulder replacement. Design Intervention systematic review with narrative synthesis. Literature search MEDLINE, EMBASE, CINAHL, Scopus and the Cochrane Library were searched from inception to the 29th of July 2021. Study selection criteria Randomised controlled trials comparing early versus delayed rehabilitation following primary anatomic, primary reverse, or revision total shoulder replacement. Data synthesis A revised Cochrane risk of bias assessment tool for randomised controlled trials was used, as well as the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. A narrative synthesis was undertaken. Results Three eligible randomised controlled trials (n = 230) were included. There was very low-quality evidence of no statistically significant difference (P > 0.05) in pain, shoulder function, health-related quality of life or lesser tuberosity osteotomy healing at 12 months between early or delayed rehabilitation. There was conflicting and very low-quality evidence of a difference between the effect of early and delayed rehabilitation on shoulder range of movement. There was limited, very low-quality evidence of statistically significantly improved pain and function (P < 0.05) in the early post-operative period with early rehabilitation following anatomic total shoulder replacement. Conclusions No differences were seen in patient-reported or clinician-reported outcomes at 12 months post-surgery between early and delayed rehabilitation following total shoulder replacement. There is very low-quality evidence that early rehabilitation may improve shoulder pain and function in the early post-operative phase following anatomic total shoulder replacement.
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Affiliation(s)
- Maria Moffatt
- 5289Manchester Metropolitan University, Manchester, UK
| | - Gareth Whelan
- 8749York Teaching Hospitals NHS Foundation Trust, York, UK
| | - Peter Gill
- 523611Northern Care Alliance NHS Group, Salford, UK
| | | | | | - Chris Peach
- 98564Manchester University Foundation Trust, Manchester, UK
| | - Ronnie Davies
- Manchester University Foundation Trust, Manchester, UK
| | - Marie Morgan
- 2102University Hospitals of Derby and Burton NHS, Derby, UK
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