A systematic review of cost-effective treatment of postoperative rotator cuff repairs.
OBJECTIVE
The Bundled Payments for Care Improvement initiative combines payment of multiple services for episodes of care into 1 bundle. Rotator cuff repair is a likely candidate for future inclusion. The objective of this study was to determine cost-effective, high-quality postoperative rehabilitation dosing and cryotherapy for patients undergoing rotator cuff repair based on systematic review of the literature.


METHODS
Systematic review of level I and level II articles was performed in PubMed, Cochrane Databases, and PEDro. Conference references and bibliographies were also reviewed. For postoperative therapy, keywords included rotator cuff, rotator cuff repair, exercise therapy, exercise, unsupervised, self-care, postoperative period, physical therapy, and physiotherapy; for cryotherapy, keywords included rotator cuff repair, shoulder, cryotherapy, and ice.


RESULTS
Five studies compared postoperative outcomes in participants assigned to supervised therapy vs. unsupervised therapy. Three found no difference between groups. One found improved outcomes in supervised therapy. Limitations included that therapies were not consistently defined and significant methodologic issues were present, decreasing the applicability and validity of the results. Five articles examined cryotherapy outcomes in the postoperative shoulder. Two studies showed improved patient outcomes with cryotherapy vs. no cryotherapy; 2 studies showed no decrease in joint space temperatures at 90 minutes but decrease in temperature at 4 to 23 hours postoperatively. One study indicated that an ice bag and Ace bandage might be as effective as continuous, compressive cryotherapy units using patient-reported outcomes.


CONCLUSIONS
Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair. Cryotherapy is favorable and cost-effective using simple methods for delivery.
Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: Rebecca.Dickinson@Vanderbilt.edu.
Rebecca N
RN
Dickinson
Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
John E
JE
Kuhn
Vanderbilt Orthopaedic Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
Jamie L
JL
Bergner
Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
Katherine H
KH
Rizzone
D001182:Arthroscopy; D003362:Cost-Benefit Analysis; D017679:Cryotherapy / Q000191:economics; D006801:Humans; D026741:Physical Therapy Modalities / Q000191:economics; D011182:Postoperative Care / Q000191:economics; D000070636:Rotator Cuff Injuries / Q000628:therapy*
Rotator cuff tear; bundled payment; cryotherapy; postoperative rehabilitation; rotator cuff repair; supervised therapy; unsupervised therapy