Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Shoulder Elbow Surg. 2024 Aug;33(8):1747-1754. doi: 10.1016/j.jse.2024.01.017. Epub 2024 Feb 18.
There is limited consensus on the optimal time to initiate supervised physical rehabilitation after a rotator cuff repair (RCR). We examined whether timing of initiating supervised physical rehabilitation was associated with repeat RCR or development of adhesive capsulitis within 12 months postoperatively in an observational cohort of commercially insured adults.
This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters Database. We included adults aged 18-64 who underwent a unilateral outpatient RCR between 2017 and 2020 and initiated supervised physical rehabilitation 1-90 days postoperatively. Multivariable logistic regression models examined the adjusted association between time of initiating supervised physical rehabilitation (1-13, 14-27, 28-41, and 42-90 days postoperatively) and each of the primary outcomes: repeat RCR and capsulitis. In a sensitivity analysis, time to rehabilitation was alternatively categorized using a data-driven approach of quartiles (1-7, 8-16, 17-30, and 31-90 days postoperatively). We report adjusted odds ratios (OR).
Among 33,841 patients (86.7% arthroscopic index RCR), the median time between index RCR and rehabilitation initiation was 16 days (interquartile range 7-30), with 39.9% initiating rehabilitation at 1-13 days. Additionally, 2.2% underwent repeat RCR within 12 months, and 12-month capsulitis was identified in 1.9% of patients. There were no significant associations between timing of initiating rehabilitation and 12-month repeat RCR (OR 0.85-0.93, P = .18-.49) or 12-month capsulitis (OR 0.83-0.94, P = .22-.63). Lack of associations between timing and outcomes was supported in sensitivity analyses.
Timing of initiating rehabilitation was not significantly associated with adverse outcomes after RCR. The finding of no increased odds of repeat RCR or capsulitis with the earliest timing may support earlier initiation of rehabilitation to accelerate return to daily activities. Findings should be replicated in another dataset of similarly-aged patients.
在肩袖修复（RCR）后开始监督下的物理康复的最佳时间存在有限的共识。我们在一个商业保险成年人的观察队列中检查了在术后 12 个月内开始监督下的物理康复的时间是否与重复 RCR 或粘连性关节囊炎的发展有关。
这项回顾性队列研究使用了 IBM MarketScan 商业索赔和就诊数据库。我们纳入了 2017 年至 2020 年间接受单侧门诊 RCR 并在术后 1-90 天内开始监督下物理康复的 18-64 岁成年人。多变量逻辑回归模型检查了开始监督下物理康复的时间（术后 1-13、14-27、28-41 和 42-90 天）与主要结果（重复 RCR 和囊炎）之间的调整关联。在敏感性分析中，通过四分位数（术后 1-7、8-16、17-30 和 31-90 天）的基于数据的方法替代了康复时间的分类。我们报告了调整后的优势比（OR）。
在 33841 名患者（86.7%关节镜索引 RCR）中，索引 RCR 与康复开始之间的中位数时间为 16 天（四分位距 7-30），其中 39.9%在 1-13 天内开始康复。此外，12 个月内有 2.2%的患者接受了重复 RCR，12 个月内有 1.9%的患者出现囊炎。开始康复的时间与 12 个月内的重复 RCR（OR 0.85-0.93，P=.18-.49）或 12 个月内的囊炎（OR 0.83-0.94，P=.22-.63）之间没有显著关联。在敏感性分析中，结果也支持了这些关联。
开始康复的时间与 RCR 后不良结果之间没有显著关联。最早的时间没有增加重复 RCR 或囊炎的可能性，这一发现可能支持更早地开始康复，以加速恢复日常活动。这些发现应在另一个类似年龄患者的数据集进行复制。
