title: A criterion based sling weaning progression (sweap) and outcomes following shoulder arthroscopic surgery in an active duty military population.
abstract: BACKGROUND
  Little objective evidence is available to guide rehabilitation protocols in regard to the sling weaning process following arthroscopy surgery of the shoulder. The purpose of this study was to establish an objective, criterion based protocol for accelerated sling weaning following shoulder arthroscopy.
  
  
  METHODS
  82 active duty service members (ADSM) underwent elective shoulder arthroscopic surgery by three orthopaedic staff surgeons. One physical therapist progressed patients through the criterion based sling weaning progression (SWEAP) protocol for each surgery and documented pain levels, sleep habits, and decrease in sling use. Preoperative and six month postoperative Quick Disability of the Arm, Shoulder, and Hand (qDASH) and Shoulder Pain and Disability Index (SPADI) scores were obtained. The ability to perform an Army Physical Fitness Test (APFT) was recorded at six months postoperative.
  
  
  RESULTS
  Patients completed sling weaning at an overall mean of 16.6 ± 5.0 days with continued use in unprotected military settings only beyond this timeframe. As patients steadily progressed out of the sling for 1 hour, 2-3 hours, and half-day periods, average pain scores decreased during these time periods at 5.0±1.2, 3.7±1.2, and 2.1±1.3 (0-10 pain scale), respectively. Patients obtained 6-7 hours of sleep or normal sleep habits at an average of 10.9±4.4 days postoperative. Overall, preoperative qDASH and SPADI scores improved from 39.8±13.0 to 2.4±2.0 and 46.4±16.1 to 3.3±3.2, respectively, at 6 months follow up. All 82 patients were able to return to deployable status. 30 (36.6%) patients required formal restrictions for the push-up portion of the APFT at six months postoperative. 7 of these 30 patients required running restrictions.
  
  
  CONCLUSIONS
  Early improvement in quality of life indicators can be obtained in the initial postoperative period with a progressive, criterion based SWEAP protocol. Patients demonstrated favorable outcomes with return to occupational and physical fitness activities. This study will guide orthopedic surgeons and physical therapists to enhance the sling weaning process during rehabilitation protocols and improve preoperative counseling sessions for accurate postoperative expectations.
  
  
  METHODS
  Retrospective Case Series; Level of evidence 4.
authors.affiliation: Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Hire
authors.affiliation: Department of Physical Therapy, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Pniewski
authors.affiliation: Department of Physical Therapy, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Dickston
authors.affiliation: Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Jacobs
authors.affiliation: Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Mueller
authors.affiliation: Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Abell
authors.affiliation: Department of Orthopaedics, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Bojescul
keywords: Shoulder arthroscopy; shoulder rehabilitation; sling weaning