Short-term Comparison of Supervised Rehabilitation and Home-based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair

Si-Jung Song, Tae-Ho Jeong, Jung-Wha Moon, Han-Vit Park, Si Yung Lee, Kyoung-Hwan Koh, Si-Jung Song, Tae-Ho Jeong, Jung-Wha Moon, Han-Vit Park, Si Yung Lee, Kyoung-Hwan Koh

Abstract

Background: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well.

Methods: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM.

Results: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], -0.255 [p=0.077], 0.068 [p=0.642], and -0.188 [p=0.196], respectively).

Conclusions: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.

Keywords: Range of motion; Rehabilitation; Rotator cuff.

Conflict of interest statement

Conflict of interest None.

Copyright © 2018 Korean Shoulder and Elbow Society.

Figures

Fig. 1.
Fig. 1.
Scapular mobilization exercise (A–C) and pendulum exercise (D) were conducted to improve the movement of the scapula before the range of motion exercise. Next, the table slide exercise for flexion (E), abduction (F), and wall climb exercise (G) were conducted. All the pictures were contained in the leaflet distributed.
Fig. 2.
Fig. 2.
Active assistive range of motion exercise for flexion (A, B), external rotation (C, D), and internal rotation (E, F) was gradually allowed as the passive motion arc increased. All the pictures were contained in the leaflet distributed.

References

    1. Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(12):3809–19.
    1. Abtahi AM, Granger EK, Tashjian RZ. Factors affecting healing after arthroscopic rotator cuff repair. World J Orthop. 2015;6(2):211–20.
    1. Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Aust J Physiother. 2004;50(2):77–83.
    1. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy. 2012;28(1):34–42.
    1. Lisinski P, Huber J, Wilkosz P, et al. Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study. Int J Artif Organs. 2012;35(1):45–54.
    1. Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):915–21.
    1. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther. 2000;30(3):126–37.
    1. Şenbursa G, Baltaci G, Atay ÖA. The effectiveness of manual therapy in supraspinatus tendinopathy. Acta Orthop Traumatol Turc. 2011;45(3):162–7.
    1. Chou CT, Hu W, Wen CS, Wang SF, Lieu FK, Teng JT. Efficacy of informed versus uninformed physiotherapy on postoperative retear rates of medium-sized and large rotator cuff tears. J Shoulder Elbow Surg. 2015;24(9):1413–20.
    1. Büker N, Kitiş A, Akkaya S, Akkaya N. Comparison of the results of supervised physiotherapy program and home-based exercise program in patients treated with arthroscopic-assisted mini-open rotator cuff repair. Eklem Hastalik Cerrahisi. 2011;22(3):134–9.
    1. Krischak G, Gebhard F, Reichel H, et al. A prospective randomized controlled trial comparing occupational therapy with home-based exercises in conservative treatment of rotator cuff tears. J Shoulder Elbow Surg. 2013;22(9):1173–9.
    1. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am. 2007;89(6):1184–93.
    1. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563–7.
    1. Koo SS, Parsley BK, Burkhart SS, Schoolfield JD. Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness. Arthroscopy. 2011;27(2):155–60.
    1. Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales. Outcomes measures after shoulder surgery. Am J Sports Med. 1999;27(2):214–21.
    1. Back YW, Tae SK, Kim MK, Kwon OJ. The effect of different starting periods of passive exercise on the clinical outcome of arthroscopic rotator cuff repair. Clin Should Elbow. 2014;17(2):57–63.
    1. Denard PJ, Lädermann A, Burkhart SS. Prevention and management of stiffness after arthroscopic rotator cuff repair: systematic review and implications for rotator cuff healing. Arthroscopy. 2011;27(6):842–8.
    1. Cho CH, Lim YJ. When does the quality of life improve after rotator cuff repair? J Korean Orthop Assoc. 2013;48(4):281–9.
    1. Arndt J, Clavert P, Mielcarek P, Bouchaib J, Meyer N, Kempf JF, French Society for Shoulder & Elbow (SOFEC) Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study. Orthop Traumatol Surg Res. 2012;98(6 Suppl):S131–8.
    1. Raab MG, Rzeszutko D, O’Connor W, Greatting MD. Early results of continuous passive motion after rotator cuff repair: a prospective, randomized, blinded, controlled study. Am J Orthop (Belle Mead NJ) 1996;25(3):214–20.
    1. Koo SS, Burkhart SS. Rehabilitation following arthroscopic rotator cuff repair. Clin Sports Med. 2010;29(2):203–11. , vii.
    1. Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF. A randomized controlled trial comparing 2 instructional approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther. 2002;32(11):548–59.
    1. Aytar A, Baltaci G, Uhl TL, Tuzun H, Oztop P, Karatas M. The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial. J Sport Rehabil. 2015;24(2):116–29.

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