Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses
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. We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/...
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| description | 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. 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. 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, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64-1.75). 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. |
| doi_str_mv | 10.1371/journal.pone.0252137 |
| format | Article |
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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. 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, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64-1.75). 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0252137</identifier><identifier>PMID: 34048450</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Bias ; Biology and Life Sciences ; Comparative analysis ; Confidence intervals ; Criteria ; Editing ; Health risks ; Medical research ; Medicine and Health Sciences ; Meta-analysis ; Methodology ; Methods ; Orthopedics ; Pain ; Patients ; Physical Sciences ; Psychology ; Rehabilitation ; Research and Analysis Methods ; Research facilities ; Rotator cuff ; Rotator cuff repair ; Shoulder ; Systematic review</subject><ispartof>PloS one, 2021-05, Vol.16 (5), p.e0252137-e0252137</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Mazuquin et al. 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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. 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, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64-1.75). 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.</description><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Comparative analysis</subject><subject>Confidence intervals</subject><subject>Criteria</subject><subject>Editing</subject><subject>Health risks</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Methodology</subject><subject>Methods</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Psychology</subject><subject>Rehabilitation</subject><subject>Research and Analysis Methods</subject><subject>Research facilities</subject><subject>Rotator cuff</subject><subject>Rotator cuff repair</subject><subject>Shoulder</subject><subject>Systematic 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Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mazuquin, Bruno</au><au>Moffatt, Maria</au><au>Gill, Peter</au><au>Selfe, James</au><au>Rees, Jonathan</au><au>Drew, Steve</au><au>Littlewood, Chris</au><au>Saul, Katherine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses</atitle><jtitle>PloS one</jtitle><date>2021-05-28</date><risdate>2021</risdate><volume>16</volume><issue>5</issue><spage>e0252137</spage><epage>e0252137</epage><pages>e0252137-e0252137</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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. 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. 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, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64-1.75). 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.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34048450</pmid><doi>10.1371/journal.pone.0252137</doi><tpages>e0252137</tpages><orcidid>https://orcid.org/0000-0002-7703-727X</orcidid><orcidid>https://orcid.org/0000-0003-1566-9551</orcidid><orcidid>https://orcid.org/0000-0002-8385-7418</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Bias Biology and Life Sciences Comparative analysis Confidence intervals Criteria Editing Health risks Medical research Medicine and Health Sciences Meta-analysis Methodology Methods Orthopedics Pain Patients Physical Sciences Psychology Rehabilitation Research and Analysis Methods Research facilities Rotator cuff Rotator cuff repair Shoulder Systematic review |
| title | Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses |
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