Rehabilitation following rotator cuff repair: A survey exploring clinical equipoise among surgical members of the British Elbow and Shoulder Society.

Bruno Mazuquin,Chris Littlewood,Marcus Bateman,Jonathan Rees,Alba Realpe,Steve Drew

doi:10.1177/17585732211059804

Abstract

BackgroundWe investigated clinical equipoise across surgical members of the British Elbow and Shoulder Society (BESS) in relation to rehabilitation following rotator cuff repair.MethodAn online survey explored clinical equipoise regarding early patient-directed versus standard rehabilitation after rotator cuff repair to inform the design of a national randomised controlled trial (RCT). It described different clinical scenarios relating to patient age, tear size, location and whether other patient-related and intra-operative factors would influence equipoise.Results76 surgeons completed the survey. 81% agreed/ strongly agreed that early mobilisation might benefit recovery; 57% were neutral/ disagreed that this approach risks re-tear. 87% agreed/ strongly agreed that there is clinical uncertainty about the effectiveness of different approaches to rehabilitation. As age of the patient and tear size increased, the proportion of respondents who would agree to recruit and accept the outcome of randomisation reduced, and this was compounded if subscapularis was torn. Other factors that influenced equipoise were diabetes and non-secure repair.ConclusionSurgical members of BESS recognise uncertainty about the effectiveness of different approaches to rehabilitation following rotator cuff repair. We identified a range of factors that influence clinical equipoise that will be considered in the design of a new RCT.

Highlights

Rotator cuff repair surgery is a common intervention indicated for patients with symptomatic rotator cuff tears.[1]
It is possible that early patient-directed rehabilitation might benefit recovery after rotator cuff repair
A total of 75 responses were obtained. 61 respondents (81.3%) strongly agreed/agreed that early rehabilitation might be beneficial for patients recovery after rotator cuff repair (Figure 1)

Summary

Introduction

Rotator cuff repair surgery is a common intervention indicated for patients with symptomatic rotator cuff tears.[1]. We have recently completed a National Institute for Health Research funded pilot and feasibility randomised controlled trial (RCT) that recruited 73 participants across five NHS hospitals comparing early patient-directed rehabilitation (discarding the shoulder sling as soon as possible following surgery and moving as pain allows) with standard. We investigated clinical equipoise across surgical members of the British Elbow and Shoulder Society (BESS) in relation to rehabilitation following rotator cuff repair. Method: An online survey explored clinical equipoise regarding early patient-directed versus standard rehabilitation after rotator cuff repair to inform the design of a national randomised controlled trial (RCT). It described different clinical scenarios relating to patient age, tear size, location and whether other patient-related and intra-operative factors would influence equipoise. Conclusion: Surgical members of BESS recognise uncertainty about the effectiveness of different approaches to rehabilitation following rotator cuff repair.

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Conclusion