Rehabilitation guidelines following arthroscopic shoulder stabilisation surgery for traumatic instability – a Delphi consensus

Abstract

BackgroundThere is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for clinical practice. MethodExpert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement. Results11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined “safe zone.” Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks.Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient’s confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score. ConclusionThis consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS. Contribution of the paper•This paper is the first to provide expert recommendations for patients undergoing rehabilitation following arthroscopic shoulder stabilisation surgery.•This paper provides clinicians and patients with expert guidance on appropriate expectations regarding functional restriction and progression following arthroscopic shoulder stabilisation surgery.•In the absence of national clinical guidelines for this patient group, these recommendations will reduce variation and improve quality of care.•The knowledge acquired from this study will also lay the foundation for clinical guidelines to be developed.•The results of this study also demonstrate the need for further, empirical work to be carried out in this area.