Shoulder
Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study

https://doi.org/10.1016/j.jse.2013.01.026Get rights and content

Purpose

To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design.

Materials and methods

Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores.

Results

The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.

Conclusion

Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.

Section snippets

Materials and methods

The MOON (Multicenter Orthopaedic Outcomes Network) Shoulder Group is a team of 16 fellowship-trained orthopaedic surgeons and research personnel from 9 geographically dispersed sites within the United States, representing both academic and private practice patient environments. This group was formed to conduct large multicenter studies on conditions of the shoulder.

From May 2004 through October 2006, the MOON Shoulder Group met regularly to formulate research questions of interest; develop and

Enrollment

The group saw 2233 rotator cuff tear patients during the enrollment period. Of these patients, 1280 were excluded for the following reasons: acute tears (38%), previous surgery (11%), bilateral disease (8%), neck disorders (6%), frozen shoulder (2%), dislocation (3%), rheumatoid disease (1%), and fracture (1%). Of the remaining 953 patients eligible to enroll in the study, 452 (47%) elected to do so. These 452 patients are followed up as a prospective cohort with rolling entry into the study.

Discussion

The key findings of this study are that physical therapy is effective in the nonoperative treatment of atraumatic full-thickness rotator cuff tears as shown by the surprisingly low rate of surgery, as well as the significant improvements in validated patient-related scores of outcome. It is interesting to note that in most patients in whom nonoperative treatment failed, this failure occurred within the first 12 weeks. It is also of interest that only approximately 1 supervised physical therapy

Conclusions

This large, multicenter prospective cohort study has shown that a specific physical therapy protocol can be very effective in treating symptoms in patients with atraumatic full-thickness rotator cuff tears. If failure is defined as patients electing to have surgery, then this program is successful in approximately 75% of patients at 2-year follow-up. Interestingly, much of the physical therapy was done at home, with patients averaging slightly more than 1 physical therapy visit per week.

Acknowledgments

The authors acknowledge the following research personnel from their respective institutions: Brooke Rode, BA, at Vanderbilt University; Linda Burnworth, Amanda Haas, MA, and Deb Hanson at Washington University in St Louis; Carla Britton, PhD, at the University of Iowa; Samuel Chu, Jessica Ryu, Patrick Grimm, Kaitlyn Lillemoe, and Brian Boyle at the Hospital for Special Surgery; Angela Pedroza, BS, at The Ohio State University; May Shishido at the University of California–San Francisco; Kari

Disclaimer

Brian G. Holloway reports that he has received royalties, stock, and consultant fees from Tornier for work related to the subject of this article.

Grant L. Jones reports that he has received research grants from Biomet and Genzyme for work related to the subject of this article.

The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this

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    This manuscript is the winner of the 2012 Neer Award for Clinical Research. Institutional review board approval was obtained at all participating sites before enrollment of the first patient: Vanderbilt University (No. 060109); University of Colorado (No. 06-0421); University of Iowa (No. 200605752); The Ohio State University (No. 200605752); Washington University in St Louis (No. 06-0634); Hospital for Special Surgery (No. 27008); University of California, San Francisco (No. H48075-29336-05); Orthopaedic Institute (Avery IRB No. 2006.049); and Knoxville Orthopaedic Institute (Brany IRB No. 07-08-88-122).

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