The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review

Abstract

Purpose

The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population.

Methods

A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria.

Results

There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1–10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion.

Conclusions

High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4–6 weeks.

Implications for Rehabilitation

• The reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.

• A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.

• Our systematic review concluded that a 12-week PT program starting with immobilization for 4–6 weeks, followed by 3–4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.

• Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.

Keywords:

• Functional outcome
• quality appraisal
• range of motion
• shoulder arthroplasty
• systematic review

Acknowledgements

Joy C MacDermid was supported by a CIHR Chair in Gender, Work and Health and the Dr. James Roth Research Chair in Musculoskeletal Measurement and Knowledge Translation.

Disclosure statement

No potential conflict of interest was reported by the author(s).