Physiotherapy treatment for atraumatic recurrent shoulder instability: Updated results of the Derby Shoulder Instability Rehabilitation Programme

Abstract

BackgroundThere is limited evidence to guide therapists in the management of patients with atraumatic shoulder instability however physiotherapy remains the recommended course of treatment. In this paper we report the updated results of a rehabilitation programme designed for this patient group. MethodA service evaluation was conducted at a large university teaching hospital in the UK between August 2013 and September 2018 including patients with atraumatic Stanmore type 2 or 3 instability. Western Ontario Shoulder Index (WOSI) and Oxford Instability Shoulder Scores (OISS) were measured at baseline and final follow-up. OISS was also repeated at every clinic visit. Patients were treated using the Derby Shoulder Instability Rehabilitation Programme until a point of agreed discharge. Results66 patients were included but 15 were lost to follow-up. Patients attended for a mean of 6.9 sessions over 30 weeks. The mean OISS (n = 51) improved from 38.00 to 21.96 (p < 0.001). Including patients that did not complete follow-up in a sensitivity analysis, the mean OISS (n = 63) improved from 38.41 to 24.46 (p < 0.001). The mean WOSI (n = 51) improved from 45.10% to 85.81% (p < 0.001). In terms of the four WOSI sub-groups: the ‘Physical’ domain improved from mean 47.98%–81.19% (p < 0.001), the ‘Sport & Work’ domain improved from mean 40.17%–82.00% (p < 0.001), the ‘Lifestyle’ domain improved from 50.73% to 83.45% (p < 0.001) and the ‘Emotions’ domain improved from 32.84% to 79.78% (p < 0.001). ConclusionFor patients with atraumatic shoulder instability the Derby Shoulder Instability Rehabilitation Programme provides significant benefit to patients in terms of pain, stability and function. Further study is required to assess whether such improvements can be sustained in the medium and long terms.