Schick Samuel, Dombrowsky Alex, Egbaria Jamal, Paul Kyle D, Brabston Eugene, Momaya Amit, Ponce Brent
Department of Surgery, Rush University, Chicago, IL, USA.
Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Clin Shoulder Elb. 2023 Sep;26(3):267-275. doi: 10.5397/cise.2023.00115. Epub 2023 Aug 8.
Physical therapy (PT) plays an important role in the recovery of function following anatomic total shoulder arthroplasty (aTSA). While several PT protocols have been published for these patients, there is no standardized protocol for aTSA rehabilitation. This lack of standardization may lead to confusion between patients and physicians, possibly resulting in suboptimal outcomes. This study examines how PT protocols provided by academic orthopedic surgery programs vary regarding therapeutic goals and activities following aTSA.
PT protocols for aTSA available online from the Accreditation Council for Graduate Medical Education accredited orthopedic surgery programs were included for review. Each protocol was analyzed to evaluate it for differences in recommendation of length of immobilization, range of motion (ROM) goals, start time for and progression of therapeutic exercises, and timing for return to functional activity.
Of 175 accredited programs, 25 (14.2%) had protocols publicly available, programs (92%) recommended sling immobilization outside of therapy for an average of 4.4±2.0 weeks. Most protocols gave recommendations on starting active forward flexion (24 protocols, range 1-7 weeks), external rotation (22 protocols, range 1-7 weeks), and internal rotation (18 protocols, range 4-7 weeks). Full passive ROM was recommended at 10.8±5.7 weeks, and active ROM was 13.3±3.9 weeks, on average. ROM goals were inconsistent among protocols, with significant variations in recommended ROM and resistance exercise start times. Only 13 protocols (52%) gave recommendations on resuming recreational activities (mean, 17.4±4.4 weeks).
Publicly available PT protocols for aTSA rehabilitation are highly variable. Level of evidence: IV.
物理治疗（PT）在解剖型全肩关节置换术（aTSA）后的功能恢复中起着重要作用。虽然已经为这些患者发布了几种PT方案，但aTSA康复尚无标准化方案。这种缺乏标准化可能会导致患者和医生之间的困惑，可能导致不理想的结果。本研究探讨了学术骨科手术项目提供的PT方案在aTSA后的治疗目标和活动方面如何不同。
纳入由毕业后医学教育认证委员会认证的骨科手术项目在线提供的aTSA的PT方案进行审查。分析每个方案，以评估其在固定时间长度、活动范围（ROM）目标、治疗性锻炼的开始时间和进展以及恢复功能活动的时间方面的差异。
在175个认证项目中，25个（14.2%）有公开可用的方案，92%的方案建议在治疗以外的时间使用吊带固定，平均时间为4.4±2.0周。大多数方案给出了开始主动前屈（24个方案，范围为1 - 7周）、外旋（22个方案，范围为1 - 7周）和内旋（18个方案，范围为4 - 7周）的建议。平均而言，建议在10.8±5.7周时达到全被动ROM，在13.3±3.9周时达到主动ROM。各方案之间的ROM目标不一致，推荐的ROM和抗阻锻炼开始时间存在显著差异。只有13个方案（52%）给出了恢复娱乐活动的建议（平均，17.4±4.4周）。
公开可用的aTSA康复PT方案差异很大。证据级别：IV级。
