Rehabilitation in Health Research Center, CIRES, Universidad de Las Americas, Santiago, Chile; Faculty of Health Sciences, Universidad SEK, Santiago, Chile.
Rehabilitation in Health Research Center, CIRES, Universidad de Las Americas, Santiago, Chile; School of Health Sciences, Physiotherapy Department, Universidad Gabriela Mistral, Santiago, Chile.
J Shoulder Elbow Surg. 2021 Jun;30(6):1393-1401. doi: 10.1016/j.jse.2020.08.034. Epub 2020 Sep 10.
The aim of this study was to analyze: (1) the differences in the pre-post change in functional outcomes after a physical therapy program by the type of massive and irreparable rotator cuff tear (MIRCT) controlling for potential confounders, and (2) the influence of lifestyle behaviors and demographic and tear tendon characteristics on function in patients over 60 years of age with conservatively treated MIRCT.
In this pre-post intervention study, 92 patients were prospectively recruited at the Clinical Hospital San Borja Arriaran, with atraumatic MIRCT, between 60 and 75 years of age (mean: 67.9 ± 4.5 years), and the mean of length of symptoms was 16.5 months (±5.7 months). Patients received a physical therapy program consisting of manual therapy and a specific exercise program of 2 sessions per week for 12 weeks. The imaging findings were performed by 2 medical radiologists who classified the rotator cuff tear according to the criteria proposed by Collins. Shoulder function, upper limb function, and pain intensity were assessed with the Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and visual analog scale (VAS), respectively. Analysis of covariance models were estimated to assess differences in MIRCT categories between functional outcomes. Multiple regression model analysis was used for the association between the change in functional outcomes and lifestyle behaviors, and demographic and tear tendon characteristics.
The results showed no pre-post change in functional outcomes by type of MIRCT in all models (P > .05). There is an association between length of symptoms (P = .000), and the baseline values of the 3 functional measures (P = .000) are associated with changes in Constant-Murley; Disabilities of the Arm, Shoulder, and Hand; and VAS. In addition, changes in VAS are associated with body mass index (BMI) (P = .000), and changes in Constant-Murley are associated with gender (P = .023), BMI (P = .000), and tobacco consumption (P = .000).
There is no difference in functional outcomes by type of MIRCT after a physical therapy program controlling for potential confounders. In addition, there is an association of length of symptoms with all functional outcomes, an association of BMI with VAS and Constant-Murley questionnaire, and an association between tobacco consumption and Constant-Murley questionnaire. Our results could influence the orthopedic surgeon's decisions; thus, not predicting the functional outcome through imaging findings could lead clinicians to reconsider the need for surgery in the treatment algorithm in patients over 60 years with MIRCT. In addition, demographic characteristics and lifestyle behaviors might be considered within the patient's evaluation and follow-up to decide on surgical interventions and evaluate the clinical course of the disease. Further studies measuring additional variables and longer follow-up are needed to confirm these results.
本研究旨在分析：（1）通过控制潜在混杂因素，比较不同类型巨大不可修复肩袖撕裂（MIRCT）患者物理治疗前后功能结局的变化；（2）生活方式行为以及人口统计学和撕裂肌腱特征对 60 岁以上接受保守治疗的 MIRCT 患者功能的影响。
在这项前瞻性干预研究中，92 名患者在临床医院 San Borja Arriaran 接受了前瞻性招募，他们均患有创伤性 MIRCT，年龄在 60 至 75 岁之间（平均：67.9 ± 4.5 岁），且症状平均持续时间为 16.5 个月（±5.7 个月）。患者接受了每周 2 次共 12 周的物理治疗方案，包括手动治疗和特定的运动方案。放射科医生 2 人根据 Collins 提出的标准对肩袖撕裂进行分类，进行影像学检查。使用 Constant-Murley、上肢功能障碍问卷（Disabilities of the Arm, Shoulder, and Hand）和视觉模拟量表（visual analog scale，VAS）分别评估肩部功能、上肢功能和疼痛强度。采用协方差分析模型评估不同 MIRCT 类型之间功能结局的差异。采用多元回归模型分析生活方式行为以及人口统计学和撕裂肌腱特征与功能结局变化之间的关联。
在所有模型中，MIRCT 类型均未显示出治疗前后的功能结局变化（P >.05）。症状持续时间（P =.000）与 3 项功能测量的基线值之间存在关联（P =.000），与 Constant-Murley、上肢功能障碍问卷和 VAS 的变化有关。此外，VAS 的变化与体重指数（body mass index，BMI）有关（P =.000），Constant-Murley 的变化与性别（P =.023）、BMI（P =.000）和吸烟有关（P =.000）。
在控制潜在混杂因素后，物理治疗方案对不同类型的 MIRCT 患者的功能结局没有影响。此外，症状持续时间与所有功能结局相关，BMI 与 VAS 和 Constant-Murley 问卷相关，吸烟与 Constant-Murley 问卷相关。我们的结果可能会影响骨科医生的决策；因此，通过影像学发现预测功能结局可能会促使临床医生重新考虑在 60 岁以上 MIRCT 患者的治疗方案中是否需要手术。此外，人口统计学特征和生活方式行为可能会在患者的评估和随访中被考虑，以便决定手术干预并评估疾病的临床病程。需要进一步的研究来测量其他变量并进行更长时间的随访，以确认这些结果。
