Adherence Patterns and Dose Response of Physiotherapy for Rotator Cuff Pathology: Longitudinal Cohort Study.

David Burns,Cari Whyne,Helen Razmjou,Philip Boyer,Robin Richards

doi:10.2196/21374

Abstract

BackgroundPhysiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; however, the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown.ObjectiveThe purpose of this study was to measure the rate and patterns of participation in physiotherapy for rotator cuff disorders, assess the dose response between physiotherapy activity and recovery, and explore patient factors predictive of physiotherapy participation.MethodsWe report a prospective longitudinal study of 42 patients undergoing physiotherapy for symptomatic rotator cuff pathology. The patients were issued a smartwatch that recorded inertial sensor data while they performed physiotherapy exercises both in the clinic and in the home setting. A machine learning approach was used to assess total physiotherapy participation from smartwatch inertial data. Primary outcomes were the Disabilities of the Arm Shoulder and Hand and numeric pain rating scale assessed every 4 weeks until 12 weeks follow-up. The relationships between participation, outcomes, and clinical patient variables were assessed in univariable analyses.ResultsMean physiotherapy exercise participation in clinic and at home were 11 minutes per week and 33 minutes per week, respectively, with patients participating in physiotherapy on 41% of days assigned to treatment. Home physiotherapy participation decreased significantly over time (P=.03). There was a statistically significant and clinically meaningful relationship between cumulative physiotherapy participation and recovery demonstrated by pain scores at 8 weeks (P=.02) and 12 weeks (P=.05) and disability scores at 8 weeks (P=.04) and 12 weeks (P=.04). Low patient expectations and self-efficacy were associated with low rates of physiotherapy participation.ConclusionsThere was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology. The findings highlight the opportunity to develop novel methods and strategies to improve the participation in and efficacy of physiotherapy exercises for rotator cuff disorders.International Registered Report Identifier (IRRID)RR2-10.2196/17841

Highlights

There was a low rate of participation in home shoulder physiotherapy exercise, and a statistically and clinically significant dose response of physiotherapy on treatment outcome in patients with rotator cuff pathology
Rotator cuff pathology is a common cause of shoulder pain and disability [1,2] and is associated with significant utilization of health care resources [3] and societal economic costs [1]
This paper presents the results of a study with the following objectives: (1) measure the rate and patterns of total participation in rotator cuff physiotherapy, (2) assess the dose response between physiotherapy activity and recovery, and (3) explore patient factors predictive of physiotherapy participation

Summary

Introduction

Rotator cuff pathology is a common cause of shoulder pain and disability [1,2] and is associated with significant utilization of health care resources [3] and societal economic costs [1]. Adherence to prescribed physical therapy exercise is considered to be essential for successful rehabilitation of both conservatively and operatively managed patients [9,10]. The concept of adherence, in the context of physiotherapy and rehabilitation, is multidimensional [14]. It includes behaviors such as attending clinical appointments, active participation in physiotherapist-supervised activities and home exercises, avoiding potentially harmful or contraindicated activities, and wearing protective or therapeutic devices. Physiotherapy is considered to be essential for the successful operative and nonoperative management of rotator cuff pathology; the extent to which patients adhere to assigned physiotherapy activities and how this impacts recovery is unknown

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Conclusion