Is a formal physical therapy program necessary after total shoulder arthroplasty for osteoarthritis?
OBJECTIVE
A retrospective analysis was conducted of 2 consecutive groups of patients undergoing total shoulder arthroplasty (TSA) for primary osteoarthritis. One group was treated with formal physical therapy (PT), and one group was treated with home-based, physician-guided PT. We hypothesized that patients with a formal postoperative PT protocol would have significantly better postoperative clinical outcomes than patients with no formal PT.


METHODS
Group A (43 patients) had a standard PT program. Group B (38 patients) had a home-based, physician-guided PT program. Clinical outcomes (preoperatively, 3, 6, and 12 months and most recent follow-up) were analyzed. A minimum sample size of 31 patients gives power to detect a 10-point American Shoulder and Elbow Surgeons (ASES) score (alpha=0.05, beta=0.80).


RESULTS
ASES and Simple Shoulder Test (SST) scores significantly improved in both groups at all follow-up periods. Forward flexion and abduction were significantly improved in group B at all time points, whereas an initial improvement in forward flexion and abduction in group A was lost at final follow-up. There were no significant differences in final ASES or SST scores between groups at final follow-up. However, forward flexion, abduction, and the Short Form-36 physical component summary in group B were significantly better than group A at final follow-up. No significant improvements in internal rotation or SF-36 mental component summary were seen within or between the groups at final follow-up. Overall, there was no difference in patient satisfaction, with 88% satisfaction in group A and 95% satisfaction in group B (chi(2)=0.471, P=.4924).


CONCLUSIONS
A home-based, physician-guided therapy program may provide adequate rehabilitation after TSA, allowing for a reduction in cost for the overall procedure.
Shoulder & Elbow Division, Florida Orthopaedic Institute, Tampa, FL, USA.
Philip J
PJ
Mulieri
Jason O
JO
Holcomb
Page
P
Dunning
Michele
M
Pliner
R Kent
RK
Bogle
Derek
D
Pupello
Mark A
MA
Frankle
D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D015397:Program Evaluation; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012785:Shoulder Joint; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome