Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study
Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study
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DOI：
10.1016/j.jse.2013.01.026
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发表时间：
2013-10-01
影响因子：
3
通讯作者：
Wright, Rick W.
中科院分区：
文献类型：
--
作者：
Kuhn, John E.;Dunn, Warren R.;Wright, Rick W.
目的：采用多中心前瞻性队列研究设计，评价特定的非手术物理疗法治疗非创伤性全层肩袖撕裂的有效性。材料和方法：同意登记的非创伤性全层肩袖撕裂患者通过问卷调查提供人口统计学、症状特征、合并症、接受手术的意愿以及与患者相关的结果评估(简写为12分、美国肩肘外科医生评分、安大略省西部肩袖评分、单项评估数字评估评分和肩部活动量表)的数据。医生记录了体检和成像数据。患者开始了一项物理治疗计划，该计划源于对文献的系统回顾，并在6周和12周后返回进行评估。在这些访问中，患者可以选择3个疗程中的1个：(1)治愈(没有正式的随访计划)，(2)改善(继续治疗，并在6周内按计划重新评估)，或(3)没有好转(提供手术)。在1岁和2岁时，通过电话联系患者，以确定他们自上次就诊以来是否接受过手术。采用具有连续性校正的Wilcoxon符号等级检验来比较初始、6周和12周的结果分数。患者报告的结果在6周和12周时显著改善。选择接受手术的患者不到25%。决定手术的患者一般在6-12周之间，很少在3-24个月之间手术。结论：采用这种物理治疗方案的非手术治疗在大约75%的患者中对非创伤性全层肩袖撕裂有效，随访2年。证据水平：IV级，病例系列，治疗研究。(C)2013年《肩肘外科杂志》董事会成员。
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.Level of evidence: Level IV, Case Series, Treatment Study. (C) 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.