A specific nonoperative physical therapy program was effective for treating atraumatic full-thickness rotator cuff tears in nearly 75% of patients, say authors of a multicenter prospective cohort study published by the Journal of Shoulder and Elbow Surgery in March.
For this study, the authors enrolled patients with atraumatic full-thickness rotator cuff tears. Using questionnaires, the patients provided data on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments, including Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale.
The authors designed a physical therapy program based on a systematic review of extant literature and evaluated patients at 6 and 12 weeks. During these evaluations, patients chose from 3 courses of action: cured with no formal follow-up scheduled; improved with subsequent therapy and a scheduled evaluation in 6 weeks; and unimproved/optional surgery. At 1 and 2 years, patients were called and asked whether they underwent surgery after their last evaluation. The authors used a Wilcoxon signed rank test with continuity correction to compare initial, 6-week, and 12-week outcome scores.
Among the 452 patients included in the study, patient-reported outcomes improved significantly at 6 and 12 weeks, say the authors. Patients had surgery less than 25% of the time and elected to do so between 6 and 12 weeks, with few undergoing surgery between 3 and 24 weeks.
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