Supervised therapy may be more effective vs. home therapy for rotator cuff rehabilitation
Click Here to Manage Email Alerts
Key takeaways:
- Rotator cuff rehabilitation supervised by a physical therapist in the clinic may be more effective than self-performed therapy at home.
- Both groups had significant improvements in all outcome measures.
Published results showed rotator cuff rehabilitation exercises supervised by a physical therapist in the clinic may more effectively reduce pain and improve range of motion vs. self-performed therapy at home.
Tansu Birinci Olgun, PT, PhD, from the division of physiotherapy and rehabilitation at Istanbul Medeniyet University in Turkey, and colleagues performed a prospective, single-blind, randomized controlled trial of 70 patients (mean age, 50.1 years) who had non-traumatic partial-thickness rotator cuff tears and no plans for surgery.
Olgun and colleagues randomly assigned 35 patients to receive professionally supervised therapy in a rehabilitation clinic and 35 patients to perform self-supervised therapy at home. The 8-week intervention consisted of two sessions per day, totaling 16 sessions. Patients who completed at least 13 sessions were included in the analysis, according to the study.
Olgun and colleagues found both groups had significant improvements in all outcome measures after the 8-week intervention. However, they found patients who received supervised therapy had significant group-by-time interaction for VAS activity scores, shoulder flexion, shoulder abduction, active range of motion and pain catastrophizing scores.
Overall, 85% of patients (n = 30) who received supervised therapy and 60% of patients (n = 21) who performed at-home therapy reported having significant improvements.
“This can be interpreted as the importance of physiotherapist-supervised exercise programs,” Olgun and colleagues wrote in the study. “Patients with high pain catastrophizing may benefit most from a physiotherapist-supervised exercise program, which might enhance their ability or willingness to perform exercises independently.”
Perspective
Back to Top
In this prospective randomized study, the authors randomly assigned 70 patients with partial-thickness rotator cuff tears into a physiotherapist-supervised exercise group and a physiotherapist-prescribed home exercise group and evaluated their physical and psychosocial health measure outcomes. While they found that both groups showed significant improvements in all measures, the physiotherapist-supervised exercise program showed significantly better scores for activity pain, active range of motion and pain-catastrophizing behavior.
This is a relevant paper because we, as orthopedic surgeons, are realizing there is a strong link between the mind and body, and we need to take both into account when treating our patients. In the era of patient-reported outcomes, it is important to understand that pain and function are closely related to fear-avoidance beliefs and the authors should be commended for delving into this topic. However, I think it is important in this paper to try to understand why the patients did better with supervised therapy vs. a home program. Is it simply that working under the direct supervision of a therapist was more effective as the exercises were done correctly? Despite questionnaires for the home therapy patients to ascertain adherence to their home program, it is possible that some patients were not as motivated on their own, and that could explain the difference? Or is it possible that, on a psychosocial level, some patients need the personal interactions and encouragement of working live with a therapist?
My sense is that the answer is more nuanced and one of the takeaways to remember is that all patients got better in both groups, so surgeons should not abandon the idea of a therapist-directed home program. However, there are certainly patients who benefit more from in-person therapy, and we need more excellent studies such as this to help us better understand who those patients are so we can continue to best meet the individual needs of our patient populations.
Collapse
Read more about
Click Here to Manage Email Alerts