A randomised trial comparing two rehabilitation approaches following reverse total shoulder arthroplasty

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Rehabilitation contributes to post-operative success following reverse total shoulder arthroplasty; however, randomised trials comparing the effectiveness of rehabilitation following reverse total shoulder arthroplasty are lacking. This study sought to determine if early, active mobilisation targeting the deltoid and the external rotator muscles, would exhibit greater improvements in post-operative outcomes compared to a delayed and deltoid-focused mobilisation programme. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Patients scheduled for reverse total shoulder arthroplasty were randomly assigned to either an early active or delayed active rehabilitation group. Patient-reported outcomes for pain and function were assessed pre-surgery and at 3, 6 and 12 months post-surgery. Objective measures (Constant Score, range of motion, isometric strength) were assessed at 3, 6 and 12 months post-surgery. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Sixty-one patients (63 shoulders) underwent reverse total shoulder arthroplasty. There were no significant interaction effects or between-group differences for any patient-reported outcomes or objective measures at 3, 6 or 12 months post-surgery. However, significantly better ( p = 0.019) active arm flexion was observed in the early active group at three months post-surgery. Significantly more patients in the early active group reported improvement in patient-reported function that reached minimal clinically important difference from three to six months post-surgery ( p = 0.016). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Early, active rehabilitation after reverse total shoulder arthroplasty is safe and effective, and may have early clinical benefits over a conservative, delayed mobilisation programme. </jats:p></jats:sec><jats:sec><jats:title>Level of evidence</jats:title><jats:p> Therapy, level 1b. Trial registered 15 June 2016 at www.anzctr.org.au (ACTRN12616000779471). </jats:p></jats:sec>

Effectiveness of early versus delayed rehabilitation following total shoulder replacement: A systematic review

“…230 participants were recruited across the three trials: 60 (26%) had an anatomic total shoulder replacement with a lesser tuberosity osteotomy 12 and 170 (74%) had a reverse total shoulder replacement without repair of the subscapularis. 17 , 18 204 patients were included in the final analyses; 100 were female and 104 were male. The mean age of participants ranged from 68.3 to 75.1 years.…”

“…randomised controlled trials. Only Edwards et al 18 opted to measure health-related quality of life in addition to shoulder specific functional outcomes. Yet sling immobilisation, shoulder pain, and limited shoulder range of movement may all have a wider impact on the patient than joint-specific measures can detect.…”

“…Denard and Lädermann however found a statistically significant difference between groups at eight weeks favouring the early rehabilitation group (P = 0.019, point estimates not provided). 12 Such early outcomes were not recorded by Edwards et al 18 Grading of evidence: There is very low-quality evidence that early rehabilitation improves pain compared with delayed rehabilitation in the early post-operative period.…”

“…Only Edwards et al 18 Grading of evidence: There is very low-quality evidence of no difference in improvement in health-related quality of life up to 12 months following total shoulder replacement with early or delayed rehabilitation.…”

“…Hagen et al 17 did not present descriptive data, however reported no statistically significant differences in change in range of movement from baseline between groups at any time point. Edwards et al 18 reported that within-group time effects were observed for both groups from three to six and 12 months post-surgery, and post-hoc t-tests revealed significantly better forward flexion measurements in the early rehabilitation group at three months post-surgery (additional data Grading of evidence: There is very low-quality conflicting evidence evaluating the effect of early and delayed rehabilitation on shoulder range of movement up to 12 months post-surgery.…”