As all 10 patients showed improved scores on the OSDQ, in spite of the long-standing nature of many of their shoulder problems, this rehabilitation programme was shown to improve shoulder function in this group of patients. The variation shown in the quality of life scores reflects the age group of this cohort who had a mean age of 75.5 years. All patients deemed their pain and function to have improved over the three-month period.
Purpose: To review the evidence for the effectiveness of therapeutic exercise for the treatment of full thickness (including massive and inoperable) tears of the rotator cuff. Relevance: There is little consensus as to the most effective treatment of full thickness and massive tears of the rotator cuff. There is consensus that the outcome of rotator cuff tendon surgery in the elderly is generally very poor. As such, exercise therapy is usually recommended for this patient group. Although commonly prescribed, the evidence to support this approach is equivocal. The aim of this study was to conduct a systematic review of the literature to determine the efficacy of exercise therapy for the management of full thickness rotator cuff tears. Methods: A systematic review was conducted to synthesise the available research literature on the effectiveness of exercise therapy for full thickness tears of the rotator cuff. Data source: Reports up to and including September 2006 were located from MEDLINE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane Database of Systematic Reviews and the Physiotherapy Evidence Database (PEDro) using the terms ''rotator cuff'' and ''tear/s'' and ''exercise'' or ''physiotherapy'' or ''physical therapy'' or ''rehabilitation''. Study selection: Studies were included if they related to full thickness rotator cuff tears and exercise. Data extraction: Two independent reviewers assessed the methodological quality of the studies. Differences were resolved by consensus. Analysis/Data synthesis: Ten studies met the inclusion criteria: eight were observational case series and two were single case studies. There were no randomised clinical trials. Results: Four studies were specific to massive rotator cuff tears. One study had a sub-group with massive cuff tears and five studies were not specific as to the size of the full thickness tear. Due to the heterogeneity of outcome measures used, it was not possible to combine results. In all studies an improvement in outcome scores was reported. Exercise programmes were well documented in five studies. Conclusions: No randomised controlled trials met the inclusion criteria and the evaluation has been based on observational studies of lower scientific merit. The findings suggest that some evidence exists to support the use of exercise in the management of full thickness rotator cuff tears. There is a definite need for well-planned randomised controlled trials investigating the efficacy of exercise in the management of full thickness and massive rotator cuff tears.T he first acknowledged description of rotator cuff (RC) tears is attributed to J.G. Smith in the London Medical Gazette 1 who described the occurrence of tendon rupture of the shoulder following injury. The four rotator cuff muscles (supraspinatus, infraspinatus, teres minor and subscapularis) fuse to form a tendon that encompasses the humeral head. The rotator cuff contributes to glenohumeral movement and functions as a dynamic stabiliser of the joint, s...
Background This article compares an exercise regime with a control treatment for the physiotherapy management of patients with massive rotator cuff tears. Methods The study design was a randomized placebo controlled trial of 60 patients with radiologically confirmed massive rotator cuff tears evaluating the change from baseline to 3 months, 6 months and 12 months in shoulder function. The primary outcome measure was the Oxford shoulder score. Results Both the control and the intervention groups had an improvement in their Oxford shoulder scores at 3 months, 6 months and 12 months. The mean improvement at 3 months was statistically significant in favour of the experimental group (p = 0.002). The mean improvement at 6 months was also statistically significant (p = 0.008) but by 12 months there was no statistically significant difference between the two groups (p = 0.16). Discussion The rehabilitation programme for patients with massive rotator cuff tears significantly improved shoulder pain and function in the short term. These improvements in shoulder pain and function were sustained over time although the advantage of intervention against control were not.
The addition of US was not superior to placebo US when used as part of a package of physiotherapy in the short-term management of shoulder pain. This has important implications for physiotherapy practice.
Advanced practice roles in nursing and other health professions have become integral to a range of healthcare services world-wide providing experienced practitioners with the opportunity to extend their roles and influence decision making whilst maintaining patient contact. However, there has been limited research to evaluate the impact on health services of these advanced practice roles.The aim of this feasibility study was to analyse Nurse and Allied Health Professionals (AHP) Consultant activity in the four functions of the role (education, expert practice, leadership, research). A structured diary assessed the activity of five Consultant Nurses and one Consultant Physiotherapist over a one week period. Detailed analysis of a clinic carried out by one of the Consultants was undertaken using a mapping procedure.Results suggest that the activity diary, combined with mapping of activities, illustrate the complexity and variety of the role and facilitate meaningful reflection on what advanced practitioners do.
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