Willmore Elaine, McRobert Cliona, Foy Chris, Stratton Irene, van der Windt Danielle
Gloucestershire Hospitals NHS Foundation Trust, UK.
School of Health Sciences, Institute of Population Health, University of Liverpool, UK.
Musculoskelet Sci Pract. 2021 Apr;52:102319. doi: 10.1016/j.msksp.2021.102319. Epub 2021 Jan 13.
Despite usually being considered necessary, the rehabilitation regime that optimises outcomes for patients following release procedures for frozen shoulder has not been established and no accepted best practice guidelines currently exist. The purpose of this study was to gain insight into what physiotherapists considered best practice and factors they considered likely to affect patient outcome.
A cross-sectional, self-administered online questionnaire was developed and distributed to UK based Physiotherapists, undergraduate students and support workers via email, social media and professional networks.
260 eligible and fully completed surveys were received. Clear preference for early (within 72 h), frequent (2-3 times per week or weekly) and prolonged (greater than 6 weeks) treatment delivered in a 1:1 setting was expressed. 99% were highly likely/likely to advocate education and advice, range of movement exercises (99.6%), stretching (73.5%) and strengthening (61.9%). More passive modalities (manual therapy, massage, electrotherapy, acupuncture) were highly unlikely/unlikely to be used and lack of manual therapy and insufficient contact with a physiotherapist were the reasons deemed least likely to affect outcome. Most clinicians (89.2%) were likely to prescribe exercises that patients reported as painful but persistent pain and poor adherence by patients to exercises were the top reasons given for poor outcome along with psychological and psychosocial patient characteristics.
Physiotherapists consistently advocate early, frequent, prolonged, 1:1 treatment following release procedures for frozen shoulder. Most patients are discharged whilst still experiencing symptoms, particularly pain. Further work is needed to establish high value pathways for this patient group.
尽管通常认为康复方案是必要的，但尚未确立能使肩周炎松解术后患者获得最佳治疗效果的康复方案，目前也没有公认的最佳实践指南。本研究的目的是深入了解物理治疗师所认为的最佳实践以及他们认为可能影响患者治疗效果的因素。
设计了一份横断面、可自行填写的在线问卷，并通过电子邮件、社交媒体和专业网络分发给英国的物理治疗师、本科学生和辅助人员。
共收到260份符合要求且完整填写的调查问卷。受访者明确倾向于在一对一的环境中进行早期（72小时内）、频繁（每周2 - 3次或每周一次）且持续时间较长（超过6周）的治疗。99%的受访者极有可能/有可能提倡进行教育与建议、活动度练习（99.6%）、拉伸（73.5%）和强化训练（61.9%）。更多的被动治疗方式（手法治疗、按摩、电疗、针灸）极不可能/不太可能被采用，而手法治疗的缺乏以及与物理治疗师接触不足被认为是最不可能影响治疗效果的原因。大多数临床医生（89.2%）可能会开出患者报告有疼痛的练习处方，但患者持续疼痛和对练习的依从性差是导致治疗效果不佳的首要原因，此外还有患者的心理和社会心理特征。
物理治疗师一致提倡在肩周炎松解术后进行早期、频繁、持续时间较长的一对一治疗。大多数患者在仍有症状，尤其是疼痛的情况下就已出院。需要进一步开展工作，为该患者群体建立高价值的治疗路径。
