Does Early Mobilisation Improve Outcomes After Rotator Cuff Repair?
Condition: Shoulder; Rehabilitation
MeSH terms: Rotator Cuff Injuries
Study type: Interventional

Summary: 
      Shoulder pain is among the most common musculoskeletal complaints, leading to high number of
      General Practioners consultations in the United Kingdom. On the top list of the disorders
      causing pain and dysfunction of shoulder is rotator cuff tears. The aetiology of rotator cuff
      tears is multifactorial and is likely to be a combination of age-related degenerative changes
      and trauma during life. It is present in approximately 25% of individuals in their 60s and
      50% of individuals in their 80s and have been shown to start developing during the 40s. To
      recover functional status of this patients group, surgical repair is often recommended, but
      for optimal results the rehabilitation is of great importance and must be adequately planned.
      After surgery a period of movement restriction is followed, however, the optimal time of
      immobilisation is unknown. As a common practice, patients use a sling for six weeks and avoid
      any activities with the affected shoulder. This period is important to protect the tendon,
      allow good healing and to possibly prevent re-tear episodes. Although, the delayed motion may
      increase the risk of postoperative shoulder stiffness, muscle atrophy and potentially delay
      improvement of functionality. Based on the available evidence, it is difficult to make a
      clinical decision for a well-programmed rehabilitation regime and establish the most
      favourable postoperative time to start it. Moreover, it is not clear if early mobilisation
      will benefit more severe stages as published studies have methodological flaws that
      compromises the clinical decision for patients with higher commitments. The question whether
      early mobilisation application is beneficial is of high importance as the results will not
      just help improving patients quality of life, but also may reduce costs as further
      complication may be avoided.
    

Detailed description: 
      The study will be a randomised controlled trial, which means that each participant will have
      equal chances to be assigned to one of 2 groups.

      The first group will start the rehabilitation after 3 weeks post-surgery and the second group
      will start after 6 weeks.

      The rehabilitation stages will start with passive movements, progressing to more active
      stages phases until full recovery. The whole program will last about 3 months, which is in
      accordance to what is normally used at the Wrightington Hospital.

      Each participant will have 4 assessment sessions: 1 pre-surgery, after 3 months post-surgery,
      after 6 months and the last after 12 months post-surgery.

      The assessment sessions will consist on answering questionnaires and a clinical assessment
      with equipment, which measures muscle activity and joint angles during clinical tasks.

      An ultrasound scan of the shoulder to assess the integrity of the rotator cuff would be
      carried out one year after surgery by a consultant radiologist.

      These assessments are timed with the routine orthopaedic clinic assessments so that patients
      do not have to make extra trips to take part in the research.
    

Intervention name(s): Physiotherapy
Intervention type(s): Other
Intervention description(s): Passive exercises, active exercises, strengthening, stretching
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Rotator Cuff Tears