Aquatic Therapy versus Standard Rehabilitation after Surgical Rotator Cuff Repair: A Randomized Prospective Study

Abstract

Introduction: Post-operative rehabilitation following rotator cuff tear repair (RCR) is important to promote tendon healing, restore strength, and recover normal function. Aquatic therapy in hot water allows body relaxation, which promotes patient conditioning for efficient rehabilitation. The aim of this study was to assess whether aquatic therapy is more efficient than standard (land-based) rehabilitation in terms of range of motion (ROM), function, and pain after arthroscopic RCR. Methods: We prospectively randomized 86 patients scheduled for arthroscopic RCR to either aquatic therapy (n = 44) or standard rehabilitation (n = 42) using block sizes of four or six. Patients were evaluated clinically at 1.5, 3, 6, and 24 months and using ultrasound (US) at 6 months. Two-way mixed ANOVA tests were performed to evaluate the effects of rehabilitation type (between-subjects factor) on ROM and patient reported outcome measures (PROMs) over time (within-subjects factor). Post-hoc inter-group comparisons at each time point were also conducted using Wilcoxon rank sum tests or unpaired Student t-tests and adjusted for multiple comparisons using the Bonferroni correction. Results: The two groups did not differ significantly in terms of demographic data or pre-operative characteristics, except for the Single Assessment Numeric Evaluation (SANE) score, which was lower in the aquatic therapy group (37.9 ± 23.6 vs. 55.6 ± 24.9, p = 0.019). The mixed model revealed the absence of interaction effect between the type of rehabilitation and time on PROMs and ROM except on the SANE score (p < 0.001), which was biased by the existing pre-operative difference mentioned above. Furthermore, none of the post-operative outcomes were statistically different between the two groups at 1.5, 3, 6, and 24 months. In addition, no significant difference could be noted regarding tendon healing rate (p = 0.443), complication (p = 0.349), workstop duration (0.585), or patient satisfaction (p = 0.663). Conclusion: Compared to the standard rehabilitation, the aquatic therapy did not yield superior clinical and functional outcomes after arthroscopic RCR when started immediately after the surgery.

Aquatic therapy following arthroscopic rotator cuff repair enables faster improvement of Constant score than land‐based therapy or self‐rehabilitation therapy

“…The temperature of the water also allows relaxation and improvement of well-being, ultimately resulting in better rehabilitation. Water-based exercises can therefore allow active motion to begin at an earlier stage than land-based exercises without compromising repair integrity [ 2 , 7 ].…”

“…There is increasing interest in aquatic therapy for rehabilitation following rotator cuff repair, though there is insufficient evidence regarding its efficacy [ 25 ], as comparative studies on this topic are based on small cohorts where aquatic therapy is considered as an additional component, rather than a substitute to land-based therapy [ 7 , 25 ]. The purpose of this study was to compare the clinical and functional outcomes of arthroscopic rotator cuff repair over a period of 2 years using three postoperative rehabilitation modalities: aquatic therapy, land-based therapy, and self-rehabilitation therapy.…”

An early, intensive and complementary aquatic rehabilitation protocol after arthroscopy rotator cuff repair: Consensus through a Delphi study

“…This protocol was early because aquatic rehabilitation will begin in the second or third week after the operation, it was intensive because there will be 12 45-minute sessions in the water for three weeks, and it was complementary because the aquatic session will be complemented by two land sessions that will be held in the rehabilitation facilities of a hospital or medical centre during the protocol. The protocol has been designed based on existing evidence [20,25,27,39,40], and the author's experience in aquatic shoulder recoveries [41]. To assess the improvement in joint balance, a simple passive anterior flexion, abduction and external rotation goniometry of the glenohumeral joint will be performed at the beginning and at the end of the protocol.…”

“…Few studies have examined the suitability of an aquatic rehabilitation programme in combination with standard treatment after rotator cuff surgical repair [20,23,26,27]. Previous studies demonstrate that an aquatic environment offers favourable conditions for the recovery of these injuries.…”

Editorial to the Special Issue “Human Bodywork: Applications in Health, Disease, and Rehabilitation”

“…From the contributing studies in this category, we can mention Martins et al [ 3 ], Cuenca-Zaldivar et al [ 4 ]. Dos Santos et al [ 5 ], Maciejczyk et al [ 6 ], Dufournet et al [ 7 ], Shabat et al [ 8 ], An et al [ 9 ], Martínez-Jiménez et al [ 10 ], Wang et al [ 11 ], Ofran et al [ 12 ], Wang et al [ 13 ], Rostron et al [ 14 ], Silva Caiado et al [ 15 ], Arenales Arauz et al [ 16 ], Souto Braz et al [ 17 ], and Van Heuvelen et al [ 18 ] with an Reporting Guidelines for Whole-Body Vibration Studies in Humans, Animals and Cell Cultures. In the third category, the optimization of athlete performance was discussed in the papers of Brambilla et al [ 19 ], Strutzenberger et al [ 20 ], and Kiers et al [ 21 ].…”