目的:本研究旨在比较术后3个月的临床结果,6个月,12个月,以及在关节镜下修复(ARCR)大量肩袖撕裂(MRCT)后接受有监督的物理治疗(PT)或家庭运动计划的患者的最新随访。
方法:对2015年1月至2018年12月期间在单个中心接受MRCTARCR后接受有监督的PT或家庭治疗的患者数据库进行了回顾性回顾,并进行了至少24个月的随访。在他们术后2周的常规随访中,患者可以在家庭PT和监督PT之间进行选择.收集患者报告的结果(PRO)和活动范围(ROM),并在术前和3个月的队列之间进行比较。6个月,12个月,和最新的后续行动。患者达到或超过最小临床重要差异(MCID)和患者接受疼痛视觉模拟量表(VAS)的症状状态(PASS)的百分比,美国肩肘外科评分(ASES),在每个时间点记录两个队列的肩峰值和主观肩峰值(SSV)。并发症,愈合,满意,并报告了重返工作岗位。在最近的随访中通过超声评估愈合。
结果:符合研究标准的患者有99例:在有监督的PT队列中有61例,在以家庭为基础的队列中,有38人。受监督的PT和以家庭为基础的队列在手术后53±20和55±16个月(p=0.496)返回诊所进行最新随访。分别。比较肌腱受累时没有差异(SS,p=0.574;IS,p=0.288;SScp=0.592),撕裂回缩(p=0.603),或高级脂肪渗透(SS,p=0.684;IS,p-0.397;SScp=0.473)基于术前MRI评估和手术相关因素,包括前(p=0.473)或后(p=0.386)幻灯片,固定结构(p=0.829),或完全修复(p=0.912)。两个队列在基线显示相似的PRO和ROM。术后3个月各组的PROs和ROM相似,6个月,12个月,和最新的后续行动。然而,在家庭队列中,ASES(71.4vs61.2;p=0.013)和FF(135°vs118°;p=0.023)在3个月的随访中明显更高。两组在3个月时分别获得了MCID和PASS,6个月,和12个月的随访。在最新的后续行动中,监督PT和基于家庭的队列在VAS方面实现了MCID和PASS(75%对81%,p=0.573;70%对72%,p=0.911),ASES(76%对74%,p=0.777;72%对72%,p=0.873),和SSV(82%对84%,p=0.734;72%对66%,p=0.489),分别。满意,愈合,并发症,恢复工作的速度相似。
结论:在最近的随访中,使用基于家庭的方案进行康复的患者在MRCTARCR后表现出与有监督的PT患者相似的功能评分和愈合。尽管家庭治疗的患者在3个月的随访中获得了更高的FF和ASES,这些指标从术后6个月开始具有可比性.对于每个时间点的PRO,类似地实现MCID和PASS。
OBJECTIVE: To compare postoperative clinical outcomes at the 3-month, 6-month, 12-month, and latest follow-up in patients undergoing supervised physical therapy (PT) or a home-based exercise program after arthroscopic repair (ARCR) of massive rotator cuff tears (MRCTs).
METHODS: A retrospective review was conducted on a prospectively maintained database of patients who underwent either supervised PT or home-based therapy after ARCR of MRCTs between January 2015 and December 2018 at a single center with a minimum 24-month follow-up. At their 2-week postoperative routine follow-up, patients were allowed to choose between home-based and supervised PT. Patient-reported outcomes (PROs) and range of motion (ROM) were collected and compared between cohorts preoperatively and at the 3-month, 6-month, 12-month, and latest follow-up. The percentage of patients reaching or exceeding the minimal clinically important difference (MCID) and patient accepted symptomatic state (PASS) for visual analog scale for pain, American Shoulder and Elbow Surgeon (ASES) score, and Subjective Shoulder Value was recorded for both cohorts at each time point. Complications, healing, satisfaction, and return to work were reported. Healing was evaluated via ultrasound at the latest follow-up.
RESULTS: Ninety-nine patients met the study criteria: 61 in the supervised PT cohort and 38 in the home-based cohort. The supervised PT and home-based cohorts returned to the clinic for their most recent follow-up at 53 ± 20 and 55 ± 16 months (P = .496) after surgery, respectively. There was no difference when comparing tendon involvement (supraspinatus, P = .574; infraspinatus, P = .288; subscapularis, P = .592), tear retraction (P = .603), or high-grade fatty infiltration (supraspinatus, P = .684; infraspinatus, P = .397; subscapularis, P = .473) based on preoperative magnetic resonance imaging assessment and surgery-related factors, including anterior (P = .473) or posterior (P = .386) slides, fixation constructs (P = .829), or complete repair (P = .912). Both cohorts showed similar PROs and ROM at baseline. Postoperative PROs and ROM were similar among groups at the 3-month, 6-month, 12-month, and latest follow-up. However, ASES (71.4 vs 61.2; P = .013) and forward flexion (135° vs 118°; P = .023) were significantly higher at 3-month follow-up in the home-based cohort. Both groups comparably achieved MCID and PASS for PROs at the 3-month, 6-month, and 12-month follow-up. At the latest follow-up, the supervised PT and home-based cohort achieved MCID and PASS for visual analog scale (75% vs 81%, P = .573; 70% vs 72%, P = .911), ASES (76% vs 74%, P = .777; 72% vs 72%, P = .873), and Subjective Shoulder Value (82% vs 84%, P = .734; 72% vs 66%, P = .489), respectively. Satisfaction, healing, complication, and return-to-work rates were similar.
CONCLUSIONS: Patients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. Although patients with home-based therapy achieved higher forward flexion and ASES at the 3-month follow-up, these became comparable starting at the 6-month postoperative mark. MCID and PASS were achieved similarly for PROs at each time point.
METHODS: Level III, retrospective case series comparison.