Effectiveness of formal physical therapy following total shoulder arthroplasty: a systematic review

Abstract

Background: Physical therapy is considered routine practice following total shoulder arthroplasty (TSA). To date, current regimens are based on clinical opinion, with evidence-based recommendations. The aim of this systematic review was to evaluate the effectiveness of TSA physical therapy programmes with a view to inform current clinical practice, as well 31 as to develop a platform upon which future research might be conducted.

Methods: An electronic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library to March 2018 was complemented by hand and citation-searching. Studies were selected in relation to pre-defined criteria. A narrative synthesis was undertaken.

Results: A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain. No studies evaluated the effectiveness of physical therapy programmes in reverse TSA procedures.

Discussion: Restoring ROM and strength following TSA is considered important for patients to obtain a good outcome post-surgery and, when applied early, may offer more rapid recovery. Given the rising incidence of TSAs, especially reverse TSA, there is an urgent need for high-quality, adequately powered RCTs to determine the effectiveness of rehabilitation programmes following these surgeries.