Move It or Lose It? The Effect of Early Active Movement on Clinical Outcomes Following Rotator Cuff Repair: A Systematic Review With Meta-analysis

Abstract

Objective To assess the effect of early active shoulder movement after rotator cuff repair, compared to delayed active shoulder movement, on clinical outcomes, rotator cuff integrity, and return to work. Study Design Intervention systematic review. Literature Search We searched 14 databases in November 2017 and updated the search in December 2018 and February 2020. Study Selection Criteria We included comparative studies that assessed the effect of early active shoulder movement versus delayed active shoulder movement following rotator cuff repair. Data Synthesis Means and SDs were used to calculate weighted mean differences and 95% confidence intervals for outcomes of interest. The sensitivity analysis included only randomized controlled trials and was performed when heterogeneity among studies was statistically significant. Results Eight studies with a total of 756 participants (early active shoulder movement, n = 379; delayed active shoulder movement, n = 377) were included. There was high-certainty evidence favoring early active movement for forward flexion (6 weeks), abduction (6 weeks), and external rotation (6 weeks and 3 and 6 months) postsurgery. There was moderate-certainty evidence of worse Western Ontario Rotator Cuff Index score (6 weeks) for the early active movement group, and no difference in rotator cuff integrity between the early and delayed active movement groups. There were no group differences for all other outcomes. Conclusion Patients who commenced active shoulder movement early after rotator cuff repair had greater shoulder range of motion and worse shoulder-specific quality of life after surgery than patients who delayed active shoulder movement. However, the group differences did not appear to be clinically important, and rotator cuff integrity was similar. J Orthop Sports Phys Ther 2021;51(7):331–344. Epub 15 May 2021. doi:10.2519/jospt.2021.9634

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer‐reviewed physiotherapy publications: A methodology review

“…A total of 68 SRs were analysed (43 with meta‐analysis; 25 without). Fifty‐seven SRs (83.8%) were registered 79–110 . Refs 8,95,97,112–133 .…”

“…Fifteen SRs (22.1%) were available open access 86,88,90,93,98,101,104,114,115,119,128,133–136 . A statement that PRISMA or similar reporting guidelines had been followed were present in 61 (89.7%) of the published studies 79,81–100,103–109,112,116,118,124,134,137–140 . Refs 8,113–115,117,119–122,125–128,130–133,135,136,141–144 .…”

“…All but one 84 of the 57 registered studies had the review question stated in the associated registration. The review question matched the registration in 29 of 57 studies (50.9%) 79,81,85,87,88,91–94,98,100,101,104,105,107,110,112–114,116,118–120,124,126,129,130,132,143 …”

“…For registered MAs ( n = 36), the review question in the study matched the associated registration in 16 (44.4%) cases 79,81,85,87,88,91,94,101,104,107,114,120,124,126,129,132 . The primary outcome matched the registration in eight of the MAs (22.2%) 79,89,94,103,107,125,127,131 .…”

“…For registered MAs ( n = 36), the review question in the study matched the associated registration in 16 (44.4%) cases 79,81,85,87,88,91,94,101,104,107,114,120,124,126,129,132 . The primary outcome matched the registration in eight of the MAs (22.2%) 79,89,94,103,107,125,127,131 . The statistical analysis plan was present in the registration and was the same in the publication for 27 cases (75.0%) 79,81,84,85,89,91,94–96,99,101–104,107,109,114,117,120,125,126,128,129,131–133,142 .…”