Efficacy and safety of different exercises in preventing cardiac implantable electronic device‐related shoulder impairment

Abstract

Background: Shoulder impairment on the implant side is common after cardiac implantable electronic device (CIED) implantation. The aim of this study was to compare the efficacy and safety of the pendulum exercise (PE) and stretching and strengthening exercises (SSE) in preventing postimplantation shoulder impairment. Methods:This prospective, randomized study collected data from 89 patients, including 30 in a control group, 31 in a PE group, and 28 in an SSE group. Shoulder functions on the implant side were evaluated by grip strength (GS), range of motion (ROM), Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and 36-Item Short-Form Survey (SF-36).Results: Shoulder median flexion and abduction ROM were significantly improved 2month postimplantation compared to two-week postimplantation in PE (156 ± 11 vs. 146 ± 10, p = .002; 147 ± 9 vs. 136 ± 9, p = .001, respectively) and SSE (158 ± 13 vs. 147 ± 11, p = .003; 149 ± 13 vs. 138 ± 9, p = .002, respectively) groups, but not in the control group. Two months after implantation, the two exercise groups showed no significant differences in any assessment. Compared with the PE and SSE groups, the control group had significantly lower GS (p = .012 and p = .002, respectively) and SF-36 physical component summary (p = .007 and p = .003, respectively) and significantly higher VAS (p = .003 and p = .001, respectively) and QuickDASH (p = .002 and p = .005, respectively) scores 2-month postimplantation.Conclusions: PE and SSE for the ipsilateral upper arm starting two-week after CIED implantation provided similar benefits in preserving shoulder girdle muscle strength, maintaining shoulder motion, relieving shoulder pain, preventing shoulder injury, and improving quality of life, without the risk of lead dislodgement.

Functional impact of cardiac implanted devices on ipsilateral shoulder range of motion, scapular mobility, and self-reported quality of life

“…Disability caused by shoulder dysfunction in CIED recipients has become a significant health problem due to the increasing number of device implants. In the last decade, prospective randomized studies demonstrated that exercises to protect shoulder ROM and shoulder girdle muscular strength have been shown to be effective and safe in preventing pain and disability following CIED implantation [ 13 – 16 ].…”

“…Existing studies have shown that early mobilization following CIED implantation is safe [ 13 – 16 ]. However, in daily practice, operators still prefer to restrict ipsilateral upper extremity movements above head level, and to even immobilize the arm on the implant side with a sling for a period of 2 to 3 weeks in order to mitigate the risks of early complications such as post-procedure hematoma and lead dislocation [ 17 , 18 ].…”

Relationship between CIED extent of displacement toward the shoulder while in the supine position and shoulder impairment

“…11 For these reasons, quality of life (QoL) is reduced in the long term in patients with CIED-related shoulder disorders. Early mobilization 12,13 and a series of upper limb exercises [14][15][16][17] after CIED implantation can safely prevent limitations, weakness, and pain, thus reducing disability and improving QoL.…”