Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.
Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Am J Sports Med. 2021 Feb;49(2):321-331. doi: 10.1177/0363546520983823. Epub 2021 Jan 20.
Traumatic full-thickness rotator cuff tears are typically managed surgically, followed by rehabilitation, but the load progression to reach an optimal clinical outcome during postoperative rehabilitation is unknown.
To evaluate whether there was a superior effect of 12 weeks of progressive active exercise therapy on shoulder function, pain, and quality of life compared with usual care.
Randomized controlled trial; Level of evidence, 1.
Patients with surgically repaired traumatic full-thickness rotator cuff tears were recruited from 2 orthopaedic departments and randomized to progressive active exercise therapy (PR) or limited passive exercise therapy (UC [usual care]). The primary outcome was the change in the Western Ontario Rotator Cuff Index (WORC) score between groups from before surgery to 12 weeks after surgery. Secondary outcomes included changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, pain, range of motion, and strength. Adverse events were registered during the intervention period.
A total of 82 patients were randomized to the PR (n = 41) or UC (n = 41) group. All 82 patients (100%) participated in the 12-week assessment and 79 in the 1-year follow-up. At 12 weeks, there was no significant difference between the groups in the change in the WORC score from baseline adjusted for age, sex, and center (physical symptoms: = .834; sports and recreation: = .723; work: = .541; lifestyle: = .508; emotions: = .568). Additionally, there was no between-group difference for the secondary outcomes including the WORC score at 1 year and the DASH score, pain, range of motion, and strength at 12 weeks and 1 year. Both groups showed significant improvements over time in all outcomes. In total, there were 13 retears (16%) at 1-year follow-up: 6 in the PR group and 7 in the UC group.
PR did not result in superior patient-reported and objective outcomes compared with UC at either short- or long-term follow-up (12 weeks and 1 year).
NCT02969135 (ClinicalTrials.gov identifier).
外伤性全层肩袖撕裂通常需要手术治疗，然后进行康复治疗，但在术后康复过程中达到最佳临床效果的负荷进展情况尚不清楚。
评估与常规护理相比，12 周渐进主动运动疗法对肩部功能、疼痛和生活质量是否有更好的效果。
随机对照试验；证据水平，1 级。
从 2 个骨科部门招募接受手术修复的外伤性全层肩袖撕裂患者，并随机分为渐进主动运动治疗（PR）或有限被动运动治疗（UC[常规护理]）组。主要结局是两组患者从术前到术后 12 周的 Western Ontario Rotator Cuff Index（WORC）评分变化。次要结局包括残疾上肢功能（DASH）问卷评分、疼痛、活动范围和力量的变化。在干预期间记录不良事件。
共 82 例患者被随机分配至 PR 组（n=41）或 UC 组（n=41）。所有 82 例患者（100%）均完成了 12 周评估，79 例完成了 1 年随访。在 12 周时，经年龄、性别和中心校正后，两组从基线到 WORC 评分的变化在物理症状（=0.834）、运动和娱乐（=0.723）、工作（=0.541）、生活方式（=0.508）和情绪（=0.568）方面无显著差异。此外，两组在 1 年时的 WORC 评分和 DASH 评分、疼痛、活动范围和力量，以及 12 周和 1 年时的次要结局均无差异。两组患者的所有结局均随时间显著改善。共有 13 例（16%）患者在 1 年随访时出现再撕裂：PR 组 6 例，UC 组 7 例。
在短期和长期随访（12 周和 1 年）时，与 UC 相比，PR 并未导致患者报告的结果和客观结果更优。
NCT02969135（ClinicalTrials.gov 标识符）。
