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

<h4>Objective</h4>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.<h4>Design</h4>Systematic review and meta-analyses.<h4&g...

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Autores principales:	Bruno Mazuquin, Maria Moffatt, Peter Gill, James Selfe, Jonathan Rees, Steve Drew, Chris Littlewood
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fa91d6696ad34c238c8799c862d45983
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spelling	oai:doaj.org-article:fa91d6696ad34c238c8799c862d459832021-12-02T20:05:27ZEffectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.1932-620310.1371/journal.pone.0252137https://doaj.org/article/fa91d6696ad34c238c8799c862d459832021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252137https://doaj.org/toc/1932-6203<h4>Objective</h4>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.<h4>Design</h4>Systematic review and meta-analyses.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Discussion</h4>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.Bruno MazuquinMaria MoffattPeter GillJames SelfeJonathan ReesSteve DrewChris LittlewoodPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0252137 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bruno Mazuquin Maria Moffatt Peter Gill James Selfe Jonathan Rees Steve Drew Chris Littlewood Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
description	<h4>Objective</h4>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.<h4>Design</h4>Systematic review and meta-analyses.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Discussion</h4>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.
format	article
author	Bruno Mazuquin Maria Moffatt Peter Gill James Selfe Jonathan Rees Steve Drew Chris Littlewood
author_facet	Bruno Mazuquin Maria Moffatt Peter Gill James Selfe Jonathan Rees Steve Drew Chris Littlewood
author_sort	Bruno Mazuquin
title	Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
title_short	Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
title_full	Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
title_fullStr	Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
title_full_unstemmed	Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.
title_sort	effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fa91d6696ad34c238c8799c862d45983
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Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses.

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