Mazuquin Bruno, Bateman Marcus, Realpe Alba, Drew Steve, Rees Jonathan, Littlewood Chris
Department of Health professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK.
Derby Shoulder Unit, University Hospitals Derby & Burton NHS Foundation Trust, Derby, UK.
Shoulder Elbow. 2022 Oct;14(5):568-573. doi: 10.1177/17585732211059804. Epub 2021 Dec 1.
We investigated clinical equipoise across surgical members of the British Elbow and Shoulder Society (BESS) in relation to rehabilitation following rotator cuff repair.
An online survey explored clinical equipoise regarding early patient-directed versus standard rehabilitation after rotator cuff repair to inform the design of a national randomised controlled trial (RCT). It described different clinical scenarios relating to patient age, tear size, location and whether other patient-related and intra-operative factors would influence equipoise.
76 surgeons completed the survey. 81% agreed/ strongly agreed that early mobilisation might benefit recovery; 57% were neutral/ disagreed that this approach risks re-tear. 87% agreed/ strongly agreed that there is clinical uncertainty about the effectiveness of different approaches to rehabilitation. As age of the patient and tear size increased, the proportion of respondents who would agree to recruit and accept the outcome of randomisation reduced, and this was compounded if subscapularis was torn. Other factors that influenced equipoise were diabetes and non-secure repair.
Surgical members of BESS recognise uncertainty about the effectiveness of different approaches to rehabilitation following rotator cuff repair. We identified a range of factors that influence clinical equipoise that will be considered in the design of a new RCT.
我们调查了英国肘与肩协会（BESS）外科成员对于肩袖修复术后康复治疗的临床 equipoise。
一项在线调查探讨了肩袖修复术后早期以患者为导向的康复治疗与标准康复治疗的临床 equipoise，以指导一项全国随机对照试验（RCT）的设计。该调查描述了与患者年龄、撕裂大小、位置以及其他患者相关因素和术中因素是否会影响equipoise相关的不同临床情况。
76 位外科医生完成了调查。81%的人同意/强烈同意早期活动可能有益于恢复；57%的人持中立态度/不同意这种方法有再次撕裂的风险。87%的人同意/强烈同意不同康复方法的有效性存在临床不确定性。随着患者年龄和撕裂大小的增加，同意招募并接受随机分组结果的受访者比例降低，如果肩胛下肌撕裂，这种情况会更加严重。影响equipoise的其他因素包括糖尿病和修复不牢固。
BESS 的外科成员认识到肩袖修复术后不同康复方法的有效性存在不确定性。我们确定了一系列影响临床equipoise的因素，这些因素将在新的RCT设计中予以考虑。
