Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study

Abstract

Purpose: To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospective cohort study design.

Materials and methods: Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via questionnaire on demographics, symptom characteristics, comorbidities, willingness to undergo surgery, and patient-related outcome assessments (Short Form 12 score, American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff score, Single Assessment Numeric Evaluation score, and Shoulder Activity Scale). Physicians recorded physical examination and imaging data. Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks. At those visits, patients could choose 1 of 3 courses: (1) cured (no formal follow-up scheduled), (2) improved (continue therapy with scheduled reassessment in 6 weeks), or (3) no better (surgery offered). Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit. A Wilcoxon signed rank test with continuity correction was used to compare initial, 6-week, and 12-week outcome scores.

Results: The cohort consists of 452 patients. Patient-reported outcomes improved significantly at 6 and 12 weeks. Patients elected to undergo surgery less than 25% of the time. Patients who decided to have surgery generally did so between 6 and 12 weeks, and few had surgery between 3 and 24 months.

Conclusion: Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years.

Keywords: Case Series; Level IV; MOON Shoulder Group; Rotator cuff tear; Treatment Study; nonoperative treatment; outcomes; physical therapy; prospective multicenter cohort.

Figure 1. 6 Week Data

The entire cohort of 422 patients has reached the six week follow-up point. Of this group 20 patients (5%)were lost to follow-up. Of the 402 patients remaining, 35 had surgery (9%).

Figure 2. 12 Week Data

The entire cohort of 422 patients has reached the 12 week follow-up point. Of this group 23 (5%)were lost to follow-up. Of the 399 patients remaining, 59 had surgery (15%).

Figure 3. 1 Year Data

The entire cohort of 422 patients has reached the one year follow-up point. Of this group 26 (6%)were lost to follow-up. Of the 396 patients remaining, 82 had surgery (20%).

Figure 4. 2 Year Data

As of March 2012, 381 patients have been enrolled in the study for at least two years. Of this group, 62 (16%) were lost to follow-up. Of the 319 patients remaining, 82 had surgery (26%).

Figure 5. Kaplan Meyer Survival Analysis Curve – Failure of Physical Therapy as a Treatment for Atraumatic Rotator Cuff Tears

Note that most patients fail the physical therapy program and elect to have surgery between 6 weeks (42 days) and 12 weeks (84 days) after initiating the therapy program.