D. Fernández Álamo1, R. Martín Perdomo1, B. Pajuelo Ecobedo1, S. Martín Pérez2, J.L. Alonso Pérez3
1Master Degree in Orthopaedic Manual Therapy, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain, 2Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain, 3Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
Background: Surgical repair of tendons is the standard treatment of the most severe cases of rotator cuff injuries (RCI). In some patients, recovery may be delayed mainly due to onset of pain or function impairment leading to a loss of quality of life. The early addition of a combination of manual therapy (MT) with exercise (Ex) in those who undergone surgery could be a good strategy to speed up rehabilitation process.
Purpose: The aim of this study was to evaluate the effectiveness of an early combination of MT with Ex to accelerate recovery of patients undergoing surgical repair of RCI.
Methods: A systematic review was performed following PRISMA statement using the MeSH keywords “arthroscopy” AND “rehabilitation” AND “rotator cuff” AND “physicaltherapy” AND “exercise” in meta-search engines Cochrane Central Register of Controlled Trials (CENTRAL) and in electronic databases MEDLINE (PubMED) and PEDro between February 7th 2020 to March 16th 2020. Eligibility criteria were the followings: (1) Randomized controlled trials (RCTs) or non-randomized controlled trials (NRCTs), (2) published between January 1st 2009 and December 31st 2019, (3) experimental group received a combination of MT with Ex (4) control group consisted of usual care, sham or electrophysical agents and (5) reported at least one outcome of pain, range of motion (ROM), function or quality of life. The methodological quality and the risk of bias of RCTs and NRCTs were blindly and independently assessed with PEDro scale, Risk of Bias-ROB 2.0 tool and ROBINS-1 tool respectively.
Results: A total of 20 full-text articles were selected of wich 5 RCTs and 1 NRCT (6 studies, n=249 subjects) were finally included and rated as good quality and moderate risk of bias. Early MT (soft tissue mobilization) and Ex (scapulothoracic and glenohumeral joint) reduce night pain at rest and during movement (3 studies, n=79 subjects) and increase active ROM in internal rotation and abduction (5 studies, n=220 subjects). In contrast, a worse functionality (3 studies, n=90 subjects) and quality of life (1 study, n=36 subjects) are seen with the same intervention.
Conclusion(s): An early intervention after RCI surgical repair based on MT with Ex shows faster recovery in pain and active ROM but not in terms of functionality and quality of life. Despite the consistency of these results, because of the low number of rigorous studies and the moderate risk of bias found, it is required more quality trials to set clinical recommendations.
Implications: The addition of early MT with Ex after RCI repair seems to be effective to reduce pain and restore joint motion but does not seem as effective to improve functionality and quality of life.
Funding, acknowledgements: No funding acknowledgments
Keywords: Manual therapy, Shoulder, Arthroscopy
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: No
Committee: No
Reason: No ethics approval is required because is a systematic review
All authors, affiliations and abstracts have been published as submitted.
