Content reporting and effectiveness of therapeutic exercise in the management of massive rotator cuff tears: A systematic review with 490 patients

Abstract

Background Massive rotator cuff tears (MRCT) account for a substantial fraction of tears above the age of 60 years. However, there are no clear criteria for prescription parameters within therapeutic exercise treatments. The aim of this study was to evaluate the effects and characteristics of therapeutic exercise treatments in patients with MRCT. Methods A systematic search was conducted in MEDLINE/PubMed, Web of Science, SPORTDiscus, SciELO, Scopus and EMBASE from inception to August 2022. Studies were included if they evaluated the effects of exercise on patients with MRCT. The risk of bias was evaluated and the Consensus on Exercise Reporting Template (CERT) was also used. A narrative synthesis without meta-analysis was performed. Results One randomized controlled trial, two non-randomized studies, six non-controlled studies, one case series and four retrospective studies were included. They ranged from serious to moderate risk of bias. The CERT reflected a poor description of the exercise programmes. Studies showed a pattern of improvements in most patient-reported outcome measures (PROM) surpassing the MCID, and active elevation range of motion. Conclusions There is limited evidence that exercise and co-interventions are effective in the management of some patients with MRCT, based on a systematic review without meta-analysis. Future research should improve content reporting. Level of evidence IV.

A scoping review of tendon transfer surgeries and postsurgical physical therapy interventions in individuals with massive rotator cuff tears

“…None provided the specific dosage or detailed prescription of the exercises (eg, type of exercise, target muscle group, frequency, duration, volume, intensity, rest) and other relevant aspects in rehabilitation such as the experience of the physiotherapist; the decision rules for the progression of the exercises; individual adaptations according to the progress of each patient; or the determination of the initial level for the load. Our findings agree with a recent systematic review exploring content reporting of therapeutic exercise for conservative treatment of massive RC tears 9 . The poor description of exercise programs evidenced by the Consensus Exercise Report Template (CERT) was highlighted in this report.…”

“…Our findings agree with a recent systematic review exploring content reporting of therapeutic exercise for conservative treatment of massive RC tears. 9 The poor description of exercise programs evidenced by the Consensus Exercise Report Template (CERT) was highlighted in this report. In the present study, it was not possible to identify and assess the exercise programs through the CERT due to the lack of reporting of the physical therapy interventions after surgery (ie, none or deficient description).…”

“…Conservative and non‐conservative treatments have been proposed for treating massive RC tears 8 . Regarding conservative treatments, a recent systematic review showed that some patients with massive RC tears could be managed satisfactorily with nonoperative treatment based on therapeutic exercise with cointerventions (ie, injections) over a 2‐year period, although the evidence is very limited 9 . Surgical interventions aim to reduce pain and improve function 10 and include several strategies such as arthroscopic debridement and partial RC repair, grafting, reverse total shoulder arthroplasty, subacromial balloon spacer, superior capsular reconstruction, and tendon transfer 11–13 …”

“…8 Regarding conservative treatments, a recent systematic review showed that some patients with massive RC tears could be managed satisfactorily with nonoperative treatment based on therapeutic exercise with cointerventions (ie, injections) over a 2-year period, although the evidence is very limited. 9 Surgical interventions aim to reduce pain and improve function 10 and include several strategies such as arthroscopic debridement and partial RC repair, grafting, reverse total shoulder arthroplasty, subacromial balloon spacer, superior capsular reconstruction, and tendon transfer. [11][12][13] A tendon transfer is a reconstructive surgical procedure that consists of the release at the point of insertion of a musculotendinous unit and its reinsertion in another point to restore the movement of a limb that has lost its function due to injury of a musculotendinous unit or a peripheral nerve injury.…”