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Early Mobilization Following Arthroscopic Rotator Cuff Repair

13 octobre 2021 mis à jour par: University of Alberta

Early Mobilization Following Arthroscopic Rotator Cuff Repair: a Randomized Controlled Trial

Shoulder rotator cuff (RC) tears are a significant cause of pain and disability. Surgery is done to reconnect the torn RC tendon(s) to the bone. The goals of RC surgery are to decrease pain, and to increase range of motion (ROM) and strength. This is done arthroscopically; through a small incision in the patient's shoulder. After surgery, patients are usually placed in a sling for up to 6 weeks to protect the repaired shoulder tendons. During this time, ROM exercises are only done by using the un-operated arm for assistance. Voluntary or active shoulder movement is usually not permitted to allow the repaired tendons to heal. Unfortunately, some patients develop shoulder stiffness while wearing the sling, which can delay rehabilitation. Any delays in rehabilitation may result in reduced shoulder function, a slower return-to-work or daily activities, and may also impact the health care system, through increased use and cost of rehabilitation.

This study's purpose is to determine if patients can safely stop wearing their sling as early as pain and comfort allow following RC surgery. A total of 200 patients (100 per group) will be randomly assigned to one of two study groups:

Patients in Group A (accelerated rehab) will wear their sling for comfort only following surgery. Self-assisted ROM exercises are allowed at any time. This means that patients may stop wearing their sling if pain and comfort allow, and start active movement for activities of daily living only.

Patients in Group B (standard rehab) will wear their sling for 6 weeks. Like in group A, self-assisted ROM exercises are allowed at any time, but active movement will not be allowed until 6 weeks after surgery. Patients in both groups will be given the same self-assisted ROM exercises after surgery.

Patients who agree to participate in the study will see their surgeon and the study physical therapist/research coordinator on 6 occasions (pre-surgery, 2 weeks, 6 weeks, 3, 6, 12 months post-surgery). Each visit will take about 30 minutes and will include a ROM assessment, strength assessment (as appropriate) and disease-specific quality of life questionnaires. Patients will also undergo an Ultrasound exam to verify that their RC repair is intact at 12-months. Differences in ROM, strength, questionnaire scores, RC integrity, and adverse events will be examined between the two groups. Differences will also be examined according to RC tear size and patient characteristics.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Type d'étude

Interventionnel

Inscription (Réel)

211

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Canada
    • Alberta
      • Edmonton, Alberta, Canada, T6G 2H9
        • Glen Sather Sports Medicine clinic

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans à 85 ans (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  1. Patient is over 18 years of age
  2. Patient has attempted non-operative treatment (i.e. physical therapy consisting of progressive ROM, strengthening, and postural exercises)
  3. Patient has a full-thickness tear of the supraspinatus and/or infraspinatus, as confirmed by appropriate diagnostic imaging (MRI, Arthrogram, Ultrasound)

Exclusion Criteria:

  1. Patient has a full-thickness tear of the subscapularis and/or teres minor
  2. Patient has undergone previous RC surgery to the affected shoulder
  3. Patient has major joint trauma, infection, or avascular necrosis
  4. Patient has chronic dislocation, inflammation, or degenerative glenohumeral arthropathy
  5. Patient has evidence of significant cuff arthropathy (superior glenohumeral translation and/or acromial erosion, as diagnosed by diagnostic imaging)
  6. Patient has a psychiatric illness, cognitive impairment, or other health condition (i.e. visual impairment) which precludes informed consent or renders the patient unable to complete study questionnaires
  7. Patient has a major medical illness where life expectancy is less than 2 years
  8. Patient does not speak/read/understand English
  9. Patient has no fixed address or means of contact
  10. Surgeon or patient has decided to cancel surgery
  11. Surgeon concludes that an arthroscopic repair is not appropriate at time of surgery (based on RC tear characteristics or concomitant shoulder pathology)
  12. Patient unwilling to complete necessary follow-ups

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Seul

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Group A (early ROM)
Group A (early ROM) will use the sling for comfort only
Procédure: No Sling
Early range of motion
Comparateur actif: Group B (usual care)
Group B (usual care) will be immobilized in a sling for 6 weeks.
Procédure: Sling
Patients will use the sling for 6 weeks, as per usual care

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Western Ontario Rotator Cuff Index (WORC)
Délai: Baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months
a 5-part (physical symptoms, sports/recreation, work, lifestyle, emotions) 21-item disease specific questionnaire. Measured in percentage. 0% = worst, 100 % = best
Baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months
Range of Motion (ROM)
Délai: baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months
Measured flexion, abduction, external rotation in 90 degrees abduction [ER(90)], internal rotation in 90 degrees abduction [IR(90)], horizontal adduction, scaption, degrees with a goniometer by the same tester throughout
baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Strength
Délai: Baseline, 6 months, 12 months, 24 months
strength was measured in pounds of force using a dynamometer (microFET3, Hoggan Health Industries, West Jordan, UT). Isometric shoulder flexion, abduction, were measured with the arm in neutral abduction and elbow at 90 degrees flexion. External and internal rotation were measured in 90 degrees of abduction. Peak values were recorded during each contraction which was held for 3 seconds. Values were expressed as raw values.
Baseline, 6 months, 12 months, 24 months
The Short Form (36) Health Survey
Délai: baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months
The Short Form (36) Health Survey is a quality of life questionnaire that looks at eight scales: physical functioning, Role-physical, bodily pain, general health, vitality, social function, role-emotional, mental health. Each scale ranges between 0 (completely disable) to 100 (completely able).
baseline, 6 weeks, 3 months, 6 months, 12 months and 24 months
Adverse Events
Délai: 2 weeks, 6 weeks, 3 months, 6months

The following complications were monitored throughout study:

  • Medical related: urinary, gastrointestinal, cardiac, pulmonary, metabolic
  • Surgical related: nerve injury, superficial or deep infection, dislocation, frozen shoulder, hematoma, biceps rupture, failure of tendon healing, dermatitis, reflex sympathetic dystrophy (RSD), persistent pain, re-injury.
  • Other

The surgeon responsible for the patient used clinical judgment to make a decision regarding if the complication was related or not to the treatment being tested (use or not of sling).
2 weeks, 6 weeks, 3 months, 6months
Pain in the Shoulder at Baseline, 6 Weeks, 3, 6, 12, 24 Months
Délai: baseline, 6 weeks, 3, 6, 12, 24 months
Shoulder pain at rest, with activity and at night were measured using a visual analogue scale of 0-10 (no pain to severe pain)
baseline, 6 weeks, 3, 6, 12, 24 months

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

University of Alberta

Les enquêteurs

  • Chercheur principal: David Sheps, MD,MSc,FRCSC, University of Alberta

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 avril 2011

Achèvement primaire (Réel)

1 avril 2015

Achèvement de l'étude (Réel)

2 mai 2018

Dates d'inscription aux études

Première soumission

8 avril 2011

Première soumission répondant aux critères de contrôle qualité

8 avril 2011

Première publication (Estimation)

12 avril 2011

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

15 octobre 2021

Dernière mise à jour soumise répondant aux critères de contrôle qualité

13 octobre 2021

Dernière vérification

1 octobre 2021

Plus d'information

Termes liés à cette étude

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • RES0005824

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