Rehabilitation following rotator cuff repair: a survey of current UK practice

Littlewood, Chris; Bateman, Marcus

doi:10.1177/1758573215571679

Cited by 22 publications

(33 citation statements)

References 8 publications

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“…Mechanical stress in the surgical site must be avoided as much as possible, to facilitate safe healing. According to a recent survey with physiotherapist and surgeons in the UK about the current practice on rotator cuff rehabilitation, 86% indicate that their patients use a sling, only 18% use a brace and 2% stated other forms of immobilisation 43. Depending on factors such as muscle involved, tear size and surgical method applied, the positioning should be different, higher abduction angles for more severe stages 44…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Mazuquin,

Wright,

Russell

et al. 2016

Br J Sports Med

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Aim/objective The aim is to critically analyse and discuss the current literature and determine the effectiveness of rehabilitation for patients after surgical repair of rotator cuff tears for range of motion (ROM), pain, functional status and retear rates; in addition, an update of new literature is included. Design Overview of systematic reviews. Data sources A search was performed with no restrictions to date of publication and language in the following databases: EBSCO, AMED, CINAHL, SPORTDiscus, EMBASE, Cochrane, LILACS, MEDLINE, PEDro, Scielo, SCOPUS and Web of Knowledge. The PRISMA guideline was followed to develop this review and the R-AMSTAR tool was used for critical appraisal of included reviews. Eligibility criteria Only systematic reviews and randomised controlled trials (RCTs) comparing the effectiveness of early with conservative rehabilitation, after surgical repair of the rotator cuff, were included. Moreover, the studies should report ROM, pain, functional status and/or retears rates before and after 3-24 months of the surgery. Results 10 systematic reviews and 11 RCTs were included for the final analysis. Conflicting results and conclusions were presented by the systematic reviews, the use of primary studies varied; also the methodological quality of the reviews was diverse. This updated review, with new meta-analysis, showed no difference for function, pain, ROM or retears ratio between early and conservative rehabilitation. Summary/Conclusions Early mobilisation may be beneficial, particularly for small and medium tears; however, more studies with higher quality are required, especially for patients with large tears who have been given less attention.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Mazuquin,

Wright,

Russell

et al. 2016

Br J Sports Med

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“…Despite surgical progression, our understanding of the optimal approach to post-operative rehabilitation, a critical component of the recovery process, is poor [6]. Rehabilitation programmes have remained largely like those initially developed when surgical techniques were less advanced and more invasive [7]. There is uncertainty about two related issues: (1) the length of post-surgical immobilisation and (2) the amount of early load permitted at the repair site [3].…”

Section: Introductionmentioning

confidence: 99%

“…There is uncertainty about two related issues: (1) the length of post-surgical immobilisation and (2) the amount of early load permitted at the repair site [3]. In the context of this uncertainty, current practice is to follow a generally cautious approach, including long periods of immobilisation in a sling (of more than 1 month) and avoidance of active rehabilitation or movement [7], possibly due to fear of failure or re-tear of the repair site. However, such long periods of shoulder immobilisation impact significantly on patient’s quality of life, including their ability to care for themselves, drive and work.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a multi-centre pilot and feasibility randomised controlled trial with a nested qualitative study: rehabilitation following rotator cuff repair (the RaCeR study)

Littlewood

Bateman

Cooke

et al. 2019

Trials

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Background Shoulder pain is a highly prevalent complaint and disorders of the rotator cuff, including tears, are thought to be the most common cause. The number of operations repair the torn rotator cuff has risen significantly in recent years. While surgical techniques have progressed, becoming less invasive and more secure, rehabilitation programmes have remained largely like those initially developed when surgical techniques were less advanced and more invasive. Uncertainty remains in relation to the length of post-surgical immobilisation and the amount of early load permitted at the repair site. In the context of this uncertainty, current practice is to follow a generally cautious approach, including long periods of immobilisation in a sling and avoidance of early active rehabilitation. Systematic review evidence suggests early mobilisation might be beneficial but further high-quality studies are required to evaluate this. Methods/design RaCeR is a two-arm, multi-centre pilot and feasibility randomised controlled trial with nested qualitative interviews. A total of 76 patients with non-traumatic rotator cuff tears who are scheduled to have a surgical repair will be recruited from up to five UK NHS hospitals and randomly allocated to either early patient-directed rehabilitation or standard rehabilitation that incorporates sling immobilisation. RaCeR will assess the feasibility of a future, substantive, multi-centre randomised controlled trial to test the hypothesis that, compared to standard rehabilitation incorporating sling immobilisation, early patient-directed rehabilitation is both more clinically effective and more cost-effective. In addition, a sample of patients and clinicians will be interviewed to understand the acceptability of the interventions and the barriers and enablers to adherence to the interventions. Discussion Research to date suggests that there is the possibility of reducing the patient burden associated with post-operative immobilisation following surgery to repair the torn rotator cuff and improve clinical outcomes. There is a clear need for a high-quality, adequately powered, randomised trial to better inform clinical practice. Prior to a large-scale trial, we first need to undertake a pilot and feasibility trial to address current uncertainties about recruitment, retention and barriers to adherence to the interventions, particularly in relation to whether patients will be willing to begin moving their arm early after their operation. Trial registration ISRCTN Registry, 18357968 . Registered on 10 August 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3407-3) contains supplementary material, which is available to authorized users.

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“…134 complete questionnaires were received (28.5% of the total 470 surgeons surveyed), a comparable response rate to previously published BESS surveys [13][14][15]. Free text comments indicated that whilst some surgeons had rejected patch repair after attempting the procedure in the past, others appeared to be interested in considering this treatment in the future.…”

Section: Resultsmentioning

confidence: 69%

The Management of large and massive rotator cuff tears- Current trends amongst UK shoulder surgeons

Cowling

2018

Open J Orthop Rheumatol

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Background: Management of large and massive rotator cuff tears remains controversial. Such tears are often irreparable, and results of treatment are unpredictable. This study documents the current practice of orthopaedic surgeons in the British Elbow and Shoulder Society. Methods: A questionnaire was prepared pertaining to the management of large and massive rotator cuff tears with minimal degenerative changes in three age groups: Patients of 50 years (young), 65 years (still active), aged 75 years (elderly) were considered. Various risk factors for failure of repair were considered. Results: Physiotherapy and arthroscopic debridement were the most commonly selected management options in young and middle groups in cases of a large/massive rotator cuff tear. Patch repairs were offered by 30% of respondents overall. Latissimus dorsi transfer was utilised by 30%, 8% and 2% respectively in each age group. Reverse shoulder replacement was indicated by 8%, 36% and 76% respectively. Discussion: There was a marked inconsistency in the pre-op planning and number and choice of options between respondents. Most surgeons offered non-augmented repairs in a scenario where they admitted failure was likely. The need for a multicenter trial is widely recognised and 87% of respondents were willing to participate in such a trial.

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Rehabilitation following rotator cuff repair: a survey of current UK practice

Cited by 22 publications

References 8 publications

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

Protocol for a multi-centre pilot and feasibility randomised controlled trial with a nested qualitative study: rehabilitation following rotator cuff repair (the RaCeR study)

The Management of large and massive rotator cuff tears- Current trends amongst UK shoulder surgeons

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