Institute of Research in Rehabilitation Medicine at Ulm University, Wuhrstrasse 2/1, Bad Buchau, Germany.
J Shoulder Elbow Surg. 2013 Sep;22(9):1173-9. doi: 10.1016/j.jse.2013.01.008. Epub 2013 Mar 22.
This pilot study evaluates the outcome after occupational therapy, compared to home-based exercises in the conservative treatment of patients with full thickness rotator cuff tears.
Forty-three adult subjects (range, 18-75 years), who had a full thickness rupture of the rotator cuff which was verified by magnetic imaging tomography, with clinical signs of a chronic rotator cuff impingement, and who were available for follow-up, were randomized to occupational therapy or to independent home-based exercises using a booklet. After drop-out, 38 patients were available for full examination at follow-up. Before therapy and after 2 months of conservative treatment, pain intensity, the Constant-Murley score, isokinetic strength testing in abduction and external rotation, functional limitation, clinical shoulder tests and health-related quality of life (EQ-5D) were evaluated.
Two-thirds of the patients improved in clinical shoulder tests, regardless of the therapy group. There were no significant differences between the groups with reference to pain, range of motion, maximum peak force (abduction, external rotation), the Constant-Murley score, and the EQ-5D index. The only significant difference observed was the improvement in the self-assessed health- related quality of life (EQ-5D VAS) favoring home-based exercises.
Home-based exercise, on the basis of an illustrated booklet with exercises twice a day, supplies comparable results to formal occupational therapy in the conservative treatment of rotator cuff tears. The results of this pilot study suggest some potential advantages related to psychological benefits using home-based treatment.
本研究旨在评估职业疗法与家庭基础锻炼在肩袖全层撕裂保守治疗中的疗效。
43 名成年患者（年龄 18-75 岁）参与了本研究，他们均经磁共振成像证实存在肩袖全层撕裂，伴有慢性肩袖撞击的临床症状，并可接受随访。所有患者被随机分为职业疗法组或家庭基础锻炼组（使用指导手册）。脱落 3 例后，38 例患者完成了随访。在治疗前和保守治疗 2 个月后，评估患者疼痛强度、Constant-Murley 评分、外展和外旋等速肌力测试、功能受限、临床肩部测试和健康相关生活质量（EQ-5D）。
无论治疗组如何，三分之二的患者在临床肩部测试中均有改善。两组之间在疼痛、活动范围、最大峰值力（外展、外旋）、Constant-Murley 评分和 EQ-5D 指数方面均无显著差异。唯一观察到的显著差异是家庭基础锻炼组在自我评估的健康相关生活质量（EQ-5D VAS）方面的改善更为显著。
基于包含每日两次锻炼的指导手册，家庭基础锻炼在肩袖撕裂的保守治疗中可取得与职业疗法相当的效果。本研究的初步结果提示，家庭基础治疗可能具有一些与心理获益相关的潜在优势。
