Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Abstract

Objective: To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity. Design: Systematic review and meta-analyses. Methods: We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool. Results: Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24-10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66-12.06), three (MD: 8.45; 95%CI: 3.43-13.47) and six months (MD: 3.57; 95%CI: 0.81-6.32) and one year (MD: 1.42; 95%CI: 0.21-2.64) and similar differences for other planes of movement. In terms of repair integrity at one year, regarding early mobilisation, the number needed to harm was 651. Discussion: Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

Factors associated with better treatment outcome of physical therapy interventions after shoulder arthroplasty: A systematic review

“…39,40,52 Other studies confirm that immediate range of motion exercises did not show any side effects in patients with rotator cuff repair, and the means of initiating a passive range of motion did not significantly affect the rate of tendon re-tear. [64][65][66][67] Early mobilization might also decrease the limitations and inconvenience caused by sling immobilization. 40 However, in patients with anatomic total shoulder arthroplasty, a higher degree of failure to heal the subscapularis was found in the immediate mobilization group.…”

Rehabilitation following rotator cuff repair: A survey exploring clinical equipoise among surgical members of the British Elbow and Shoulder Society

“…A recent systematic review suggested that early rehabilitation may be beneficial to patients with no additional risk imposed to the repair integrity. 8 However, only a minority of the RCTs that were included in the systematic review recruited patients with large tears. The RCT from Sheps, Silveira, 9 the largest completed to date ( n = 206), included patients with large tears in their sample.…”