title: Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews.
abstract: OBJECTIVE
  The aim is to critically analyse and discuss the current literature and determine the effectiveness of rehabilitation for patients after surgical repair of rotator cuff tears for range of motion (ROM), pain, functional status and retear rates; in addition, an update of new literature is included.
  
  
  METHODS
  Overview of systematic reviews.
  
  
  METHODS
  A search was performed with no restrictions to date of publication and language in the following databases: EBSCO, AMED, CINAHL, SPORTDiscus, EMBASE, Cochrane, LILACS, MEDLINE, PEDro, Scielo, SCOPUS and Web of Knowledge. The PRISMA guideline was followed to develop this review and the R-AMSTAR tool was used for critical appraisal of included reviews.
  
  
  METHODS
  Only systematic reviews and randomised controlled trials (RCTs) comparing the effectiveness of early with conservative rehabilitation, after surgical repair of the rotator cuff, were included. Moreover, the studies should report ROM, pain, functional status and/or retears rates before and after 3-24 months of the surgery.
  
  
  RESULTS
  10 systematic reviews and 11 RCTs were included for the final analysis. Conflicting results and conclusions were presented by the systematic reviews, the use of primary studies varied; also the methodological quality of the reviews was diverse. This updated review, with new meta-analysis, showed no difference for function, pain, ROM or retears ratio between early and conservative rehabilitation.
  
  
  CONCLUSIONS
  Early mobilisation may be beneficial, particularly for small and medium tears; however, more studies with higher quality are required, especially for patients with large tears who have been given less attention.
authors.affiliation: Allied Health Research Unit, University Central of Lancashire, Preston, Lancashire, UK.
authors.forename: Bruno Fles
authors.initials: BF
authors.lastname: Mazuquin
authors.affiliation: North West Deanery, Manchester, Lancashire, UK.
authors.forename: Andrew Charles
authors.initials: AC
authors.lastname: Wright
authors.affiliation: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Russell
authors.affiliation: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors.forename: Puneet
authors.initials: P
authors.lastname: Monga
authors.affiliation: Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
authors.forename: James
authors.initials: J
authors.lastname: Selfe
authors.affiliation: Allied Health Research Unit, University Central of Lancashire, Preston, Lancashire, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Richards
mesh_terms: D000072700:Conservative Treatment; D006801:Humans; D010146:Pain; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000534:rehabilitation* / Q000601:surgery*
keywords: Evidence based review; Rehabilitation; Rotator cuff; Shoulder