Rotator Cuff Repair Rehabilitation: A Level I and II Systematic Review.
Rotator Cuff Repair Rehabilitation: A Level I and II Systematic Review.
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DOI：
10.1177/1941738108331200
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发表时间：
2009-03
期刊：
影响因子：
3.3
通讯作者：
Wright RW
中科院分区：
文献类型：
--
作者：
Baumgarten KM;Vidal AF;Wright RW
对于肩袖修复术后的最佳康复方案，目前还没有达成共识。确定文献中是否有足够的I级或II级证据可用于建立统一的最佳肩袖康复方案。对1966年至2008年期间发表的I级和II级英语前瞻性随机对照试验进行了系统综述。评价MEDLINE、EMBASE、科克伦系统评价数据库和二级参考文献中符合纳入标准的研究。检索词包括肩袖、冈上肌、冈下肌、肩胛下肌、小圆肌、康复、康复、物理治疗和物理治疗。纳入标准为英语I级或II级研究，包括涉及肩袖修复康复的随机临床试验。排除标准为非英语、IV级或V级研究，或涉及肩袖修复以外的肩关节康复诊断的研究。3名独立评审员达成共识，在文献检索确定的12项研究中，将4项研究纳入本综述。纳入的研究由3位作者各自独立进行工作表质量评估，以确定优势、劣势和偏倚。然后，作者之间讨论了质量评价，并就纳入研究的优势、劣势和价值达成了共识。两项研究检查了连续被动运动在肩袖康复中的应用，两项研究比较了无监督的标准化康复计划与有监督的个性化康复计划。这些研究不支持在肩袖康复中使用持续被动运动，与无监督的标准化家庭计划相比，监督的个性化康复方案没有优势。每项调查都有研究设计上的弱点，降低了调查结果的有效性。没有足够的高水平证据来制定一个基于循证医学的方法来进行肩袖康复。需要设计良好的I级和II级试验来阐明最佳肩袖修复康复方案。
There is no consensus for the optimal postoperative rehabilitation protocol after rotator cuff repairs. To determine if there is sufficient level I or II evidence available in the literature for establishment of a uniform, optimal rotator cuff rehabilitation protocol. A systematic review of level I and II English-language, prospective, randomized controlled trials published between 1966 and 2008 was performed. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies that met the inclusion criteria. Search terms included rotator cuff, supraspinatus, infraspinatus, subscapularis, teres minor, rehab, rehabilitation, physical therapy, and physiotherapy. Inclusion criteria were English-language level I or level II studies, including randomized clinical trials involving the rehabilitation of rotator cuff repairs. Exclusion criteria were non-English language, level IV or V studies, or studies involving shoulder rehabilitation of diagnoses other than rotator cuff repairs. Three independent reviewers arrived at a consensus for including 4 studies in this review out of 12 studies identified by the literature search. Included studies underwent worksheet quality appraisal independently by each of the 3 authors identifying strengths, weaknesses, and biases. The quality appraisal was then discussed among the authors and consensus reached regarding the strengths, weaknesses, and value of the included studies. Two studies examined the use of continuous passive motion for rotator cuff rehabilitation, and 2 studies compared an unsupervised, standardized rehabilitation program to a supervised, individualized rehabilitation program. These studies did not support the use of continuous passive motion in rotator cuff rehabilitation, and no advantage was shown with a supervised, individualized rehabilitation protocol compared to an unsupervised, standardized home program. Each investigation had weaknesses in study design that decreased the validity of its findings. There is not enough high-level evidence to develop an evidence-based medicine approach to rotator cuff rehabilitation. There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol.