Enhanced rehabilitation guidance after arthroscopic capsulolabral repair of the shoulder: a randomized controlled trial.
Juhani Multanen, Pauli Kiuru, Kirsi Piitulainen and 3 others
PMID 32380852WHAT IT FOUND
After shoulder capsulolabral repair, extra home exercises plus physiotherapy control visits did not improve self-reported function, quality of life, range of motion, or strength more than usual home exercise at 12 months.
Key findings
01The added home exercise program with physiotherapy control visits did not produce significant between-group differences in self-reported disability, quality of life, range of motion, or strength at 12 months.
02Both groups showed significant improvement in self-reported disability, Physical Functioning, Role-Physical, and Bodily Pain scores, and in all measured range of motion and strength values, by 12 months.
03During the last six months, 22% of the exercise group performed strength exercises at the target level and 22% performed mobility exercises at the target level.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The authors said the small study population and low training adherence made it not realistic to expect major differences between groups. During the last six months, 22% of the exercise group performed strength exercises at the target level and 22% performed mobility exercises at the target level. Patients and physiotherapists were not blinded to group assignment, although the outcome assessor was blinded. The control group's home exercise frequency was not monitored, so usual-care activity levels are unknown. Many patients had high baseline self-reported shoulder function, and the authors described a ceiling effect on the American Shoulder and Elbow Surgeons score. The trial was reported more than 10 years after completion. This report covers only the anterior labrum rupture exercise program from a registration that included two trials.
Declared interests
The author(s) declared no potential conflicts of interest. The work was supported by the Medical Research Foundation of the Central Finland Health Care District, and the funder had no role in study design, data collection and analysis, decisions to publish, or preparation of the manuscript. Juhani Multanen was funded by the Academy of Finland (grant no. 311587) and the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (grant no. VTR-2018) when preparing the manuscript.
The easy way to misread this
Do not read the null between-group result as evidence that shoulder exercise after capsulolabral repair does not help. Both groups improved, the study was small, patients and physiotherapists knew group assignment, and the added program had low adherence, with 22% of the exercise group reaching the target strength and mobility frequency in the last six months.