The Effects of Physiotherapy on the ROM of Rotary Cuff Repair

   

Introduction

            Rotator cuff injuries (RCI) are those that have a direct impact on shoulder range of motion (ROM) (Houck et al. 2017). Individuals with rotator cuff related injuries have trouble with abduction and flexion of the shoulder (Houck et al. 2017). RCI can be divided into two categories; partial and complete tears (Zhang et al. 2017). In a partial tear the tear is either on the synovial-side or bursal-side (Zhang et al. 2017). Complete tears can be separated into transverse or longitudinal tears (Zhang et al. 2017). Pain can result from a shoulder abduction of 70-120 degrees. If left untreated RCI can reduce the overall quality of one’s life.

            There remains a debate of which rehabilitative method works best at improving overall range of motion after arthroscopic repair. The ever-growing cost in medical expenses makes rehabilitations options such as physical therapy out of reach for many without healthcare. Other options include independent home exercise prescribed by a physical therapist or rehabilitation professional (Poala J. 2013). This method would allow for a patient to schedule fewer in-patient appointments with a physical therapist while working independently on rehabilitation rotator cuff exercises at home reducing overall medical cost.

 Problem

            The purpose of this study is to identify the most effective physical therapy rehabilitation methods on the ROM of rotary cuff repair patients.

 Data Source

            Studies used in this researched met the inclusion criteria if they were published no earlier than 2013 or later. It includes only studies dealing with physiotherapy. It includes only studies whose subjects sustained rotary cuff injury. Includes only studies written in English. Including only studies that take place in rehabilitation settings. Database used for research was Cal U Manderino Library and Google Scholar. Words search included; physiotherapy. Rotator cuff repair, physical therapy.

Di Paola, John (2013) Limited physical therapy utilization protocol
does not affect impairment and disability in Workers’ Compensation patients after rotator cuff repair:
a short-term follow-up study. J Shoulder Elbow Surgery

            John Di Paola is an Orthopedic Surgeon who founded Occupational Orthopedics, a company that provides healthcare to injured workers. Dr. Di Paola attended Oregon Health Science University and performed two years of residency training in General Surgery and four years of additional Orthopedic surgery residency. Dr. Di Paola has spoken at numerous regional and national meetings, teaching other specialist about treating injured workers. Dr. Di Paola grew his passion of treating the working class from being a blue color worker himself while paying for medical school.

            Dr. Di Paola’s study, Limited physical therapy utilization protocol does not affect impairment and disability in Workers Compensation patients after rotator cuff repair, researches the effects of independent rehabilitation protocol on impairment rate after rotator cuff repair. This study is of much relevance to the topic that I have chosen for my research paper because it gives insight to the effects of different methods of physical therapy on patients with rotator cuff repairs. Dr. Di Paola’s study followed 71 post rotator cuff repair patients serrating into two groups. Group A consisted of patients who would use traditional physical therapy rehabilitation methods in order to increase range of motion and decrease impairment. Group B consisted of patients prescribed with an independent rehabilitation program where they were given exercise to work on at home. By using both a observational group and controlled group the author allows himself the ability to compare groups and determine whether his hypothesis is indeed accurate or not. The study proves that use of an independent rehabilitation program produced a reduction in physical therapy utilization without any negative effects on impairment or disability rate. This initial study by Dr. Di Paola proves that independent rehabilitation programs can be efficient and effective at improving ROM of patients with rotator cuff repair.

Zhang, J., Bai, D, Yang, J., Luan Y, Zhao, C. (2017) Early motion versus immobilization for arthroscopic repair in the treatment of large size rotator cuff tears. Biomedical Research       

           

            The purpose of the study by Zhang et. Al (2017) was to study the differences in effects of different rehabilitation methods on patients with rotator cuff repairs. This relevant to my research because it gives significant data on the effects of traditional physical therapy methods versus independent rehabilitation methods. One hundred thirty-two rotator cuff tear cases were collected and divided into two group. By using a large number of patients, the author can determine the reliability and accuracy of the study. The observational group, consisting of sixty-six patients, started exercises twenty-four hours post-surgery while the controlled group stayed immobilized.  The study concluded that early mobilization decreases the likelihood of stiffness after rotator cuff repair.

Pitulainen, K., Hakkinen, A., Salo, P. (2014) Does adding a 12-month exercise programme to usual care after a rotator cuff repair effect disability and quality of life at 12 months? A randomized controlled trial. Clinical Rehabilitation

            The purpose of this study is to compare 12 months of independent home-based program with traditional clinical physical therapy. This study is directly related to my research paper because it compares different methods of physical therapy and its effects on rotator cuff repairs. Sixty-seven, patients, whose average age was fifty-four, were separated into a experimental group and usual care group. The experimental group was given home muscle strengthening exercises to perform over the course of twelve months while the usual care group saw a physical therapist for twelve months. The study concluded that both the home strengthening exercise and usual care program were equally as effective at improving disability and quality of life. In comparison with Dr. Di Paola’s study earlier reviewed, both the findings of Di Paola and Pitulainen agree that an independent rehabilitation program is just as effective as in-patient clinical physical therapy.

Conclusion 

 The study concluded that both the home strengthening exercise and usual care program were equally as effective at improving disability and quality of life. In comparison with Dr. Di Paola’s study earlier reviewed, both the findings of Di Paola and Pitulainen agree that an independent rehabilitation program is just as effective as in-patient clinical physical therapy.

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Reference

Houck, D. A, Kraeutler, M. J, Schuette H. B, McCarty, E. C, Bravman, J. T. (2017) Early Versus Delayed Motion After Rotator Cuff Repair. Clinical Sports Medicine Update.

Poala, J. D. (2013) Limited physical therapy utilization protocol does not affect impairment and disability in workers’ compensation patients after rotator cuff repair: a short-term follow-up study. Journal of Shoulder and Elbow Survey

Zhang J. Bai, D, Yang, J, Luan, Y, Zhao, C (2017) Early motion versus immobilization for arthroscopic repair in the treatment of large size rotator cuff tears. Biomedical Research