Gloucestershire Hospitals NHS Foundation Trust, United Kingdom.
University Hospitals of Derby & Burton NHS Foundation Trust, United Kingdom.
Physiotherapy. 2024 Sep;124:154-163. doi: 10.1016/j.physio.2024.05.001. Epub 2024 May 16.
There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice.
Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement.
11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined "safe zone." Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks. Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient's confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score.
This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS. CONTRIBUTION OF THE PAPER.
在英国，关节镜下肩关节稳定术（ASSS）后康复没有统一的方法。本研究旨在为临床实践达成一套术后指南。
通过专业网络和患者参与团体确定了专家利益相关者（外科医生、物理治疗师和患者）。进行了三阶段在线德尔菲研究。共识定义为 OMERACT 阈值的 70%一致。
11 名外科医生、22 名物理治疗师和 4 名患者参与了研究。与会者一致认为，患者应常规在吊带中固定 3 周，但如果能够做到，可更早地去除吊带。在固定期间，患者只能在规定的“安全区”内移动。允许的功能活动包括使用餐具、举起饮料、切片面包、使用厨房用具、擦拭桌子、轻尘、拉起衣物、清洗/干燥餐具。避免关闭汽车门或倒酱汁。4 周后可以开始进行全范围运动，6 周后可以进行抗阻运动。患者可以根据自己的感觉恢复轻工作，并在 12 周后恢复手动工作。当达到回归比赛的功能标志物时，可恢复非接触性运动。在至少 12 周后，根据功能和信心，恢复接触性运动。在确定康复进展时，还需要考虑其他因素：功能/身体里程碑、患者的信心和运动恐惧的存在。首选的结果衡量标准是牛津不稳定肩部评分。
本共识为 ASSS 后康复指南的制定提供了专家建议。本研究的贡献。
