Rethinking the Role of Formal Physical Therapy in Glenohumeral Osteoarthritis: A Nationwide Study Comprising More than Two Million Patients in the United States

Abstract

Introduction: This study aims to determine whether incorporating physical therapy into a nonsurgical approach can effectively manage the course of glenohumeral osteoarthritis (OA) and potentially prevent patients from requiring total shoulder arthroplasty (TSA). Methods: This retrospective cohort consisted of patients diagnosed with glenohumeral OA between 2010 and 2021 using ICD-9, ICD-10, and current procedural terminology codes in the PearlDiver database. Two- and five-year TSA rates were compared between patients who had physical therapy within 1 year after glenohumeral OA diagnosis and patients who did not. Results: The study consisted of 2,710,463 patients with glenohumeral OA. After propensity score matching, among patients with corticosteroid injection, patients who received physical therapy had significantly higher 2- and 5-year TSA rates compared with those without physical therapy (2-year TSA: 0.60% vs. 0.35%, OR [95% CI]: 1.74 [1.50, 2.01] and 5-year TSA: 1.13% vs. 0.65%, OR [95% CI]: 1.74 [1.56, 1.93]). A similar association was also significant among patients without corticosteroid injection (0.35% vs. 0.16%, OR [95% CI]: 2.17 [2.03, 2.21] and 0.78% vs. 0.37%, OR [95% CI]: 2.11 [2.01, 2.21]). Conclusion: Individuals who had physical therapy as a part of their nonsurgical treatment did not have any decrease in the probability of requiring TSA.