Effectiveness of early versus delayed rehabilitation following total shoulder replacement: A systematic review.
Maria Moffatt, Gareth Whelan, Peter Gill and 6 others
PMID 34723708WHAT IT FOUND
Early shoulder rehab after replacement showed no clear benefit over delayed rehab at 12 months.
One small trial found better pain and function scores in the first eight weeks, but the evidence is very low quality and inconsistent across studies.
Key findings
01The review found no difference in patient-reported or clinician-reported outcomes at 12 months post-surgery between early and delayed rehabilitation.
02There is some limited, very low-quality evidence that early rehabilitation improved pain and function scores in the first eight weeks after anatomic total shoulder replacement.
03The evidence is very low to low quality due to substantial heterogeneity in interventions and insufficient data for meta-analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only three randomised controlled trials were included, with a total of 204 participants analysed. Substantial heterogeneity existed in the definition of 'early' versus 'delayed' rehabilitation, making direct comparison difficult. Insufficient data prevented a meta-analysis, resulting in a narrative synthesis only. The quality of evidence was rated as very low to low, with conflicting results between studies. Point estimates for significant short-term findings in one trial were not provided, so clinical importance is unknown.
Declared interests
No specific external funding was sought. One author is supported by a National Institute for Health Research Fellowship. The authors declared no other conflicts of interest.
The easy way to misread this
Do not assume early mobilisation is superior based on the short-term gains seen in one small trial. The evidence is very low quality, inconsistent across studies, and shows no benefit at 12 months. The definition of 'early' varied greatly between the included trials.