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    Early ROM Exercise a Mixed Bag for Patients After Arthroscopic Rotator Cuff Repair

    According to a new meta-analysis of randomized controlled trials, early passive range of motion (ROM) exercises for patients with arthroscopic rotator cuff repair can speed recovery—but only in certain ways, and only on the right patients. When applied to those with large-sized tears, early exercise can actually cause improper healing, and even lead to subsequent injury.

    Researchers reviewed 6 randomized clinical trials that included a total of 482 participants who received arthroscopic surgery for degenerative rotator cuff tears and underwent either early passive range of motion exercises 1 day to 1 week after surgery or a "traditional" rehabilitation program that began exercise 6 to 8 weeks after surgery. Follow-up assessment periods ranged from 6 to 24 months, with the latest assessment for most of the trials at 1 year after surgery. Results of the study were e-published ahead of print in the August 20 issue of the American Journal of Sports Medicine (abstract only available for free).

    While the findings identify benefits of early ROM exercise, particularly in terms of gains in shoulder forward flexion, authors note that early ROM exercises did not demonstrate any superiority when it came to external rotation degrees or overall shoulder function. "Our findings indicated that the benefits of early ROM exercise were specific to the dimension of applied shoulder movement and were likely to prevent shoulder stiffness through rapid ROM restoration," they write. Overall, "early ROM exercise is likely to be better than a delayed protocol in ameliorating postoperative shoulder stiffness." Still, they note, early ROM exercise did not improve overall shoulder function over delayed implementation.

    However, they warn, the approach isn't for everybody, and can actually create problems for patients with rotator cuff tears greater than 3 cm, which is a risk factor for failed surgery. In cases of such failed surgeries, early ROM exercise can actually result in improper healing and contribute to subsequent tear.

    While early ROM exercise can help patients at low risk of improper healing and higher risk for stiffness, authors write, patients at higher risk for improper healing should not undergo the early intervention. Authors add that they favor a delayed protocol for patients at low risk of both improper healing and stiffness "in consideration of the lower cost and similar efficacy in shoulder function recovery to that of early ROM exercise."

    In the end, they write, the choice to engage in early ROM exercise depends on clinical judgment that balances benefit and risk. "A proper choice of either rehabilitation protocol should be established based on an assessment of the risks between recurrent tears and postoperative shoulder stiffness," authors write.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    Comments

    So what PROM was performed?? Vast differences in what is done - self vs clinician, mobs/stretches, directions, etc. All would potentially influence outcomes.
    Posted by dano napoli on 8/25/2014 2:36 PM
    Agree with previous comment...what was done? Most exercises such as Codmans are worthless or worse and I see PTs do them routinely. Same as pulleys! I see my RCR big or small maybe 6x with great results. Research also shows likely to have good outco
    Posted by Ed Scott PT,DPT,OCS on 8/29/2014 6:58 PM
    I wonder when PTs are going to figure out that the predictors of delayed recovery after a traumatic event- and surgery is certainly traumatic at least on a tissue level- are psychosocial factors, such as catastrophizing, low self-efficacy, and, in the case of injured workers, concerns about returning to work (co-worker and employer relationships). It's not acceptable that PTs are causing iatrogenic injuries to patients after RC repairs because they simply lack the understanding of who is likely to not recover as expected. We need to wake up!
    Posted by John Ware, PT on 9/1/2014 11:22 AM
    Would you share what you do to complete rehab in 6 visits?
    Posted by Karen Brown on 9/2/2014 10:43 AM
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