Exercise rehabilitation and functional recovery following reverse total shoulder arthroplasty

This research is a prospective randomised control trial (RCT) investigating the benefit of a structured postoperative exercise rehabilitation program in patients undergoing reverse shoulder arthroplasty (RSA). The purpose of this study is to investigate the capacity in which structured post-surgery exercise programs can improve patient strength, active range of motion (AROM) and early functional recovery after RSA, compared with control subjects who receive the usual course of care. Following RSA surgery, patients will be placed in an immobilisation sling for 4 to 6 weeks and instructed to adhere strictly to the activity restrictions set by their surgeon. All patients will be educated on optimal management for reducing pain and/or swelling, as well as safely removing and fitting of the sling and clothing, and all contraindications and precautions associated with the surgical procedure. In-patient exercises will focus on safe passive range of motion (PROM) of the shoulder, as well as AROM of the hand, wrist and elbow. As mentioned above, these exercises will also be developed into a home exercise program (HEP) for patients to continue with in the comfort of their home. Following hospital discharge, all patients are followed up by their respective surgeon 2 weeks’ post-surgery to tend to the surgical wound, and then again at 6 weeks’ post-surgery for routine follow-up. From the 2-week time point, patients randomised to the usual management group (UM) will receive routine mobility exercises aimed at progressing their shoulder movement. Patients randomised to the DARE exercise group will receive these same standard exercises, with additional light, submaximal muscle contractions around the shoulder to boost early strength. These include sub-maximal isometric contractions of the deltoid and external rotators lasting 10 seconds, and for 1 set of 10 repetitions, and advanced passive flexion and external rotation ROM exercises, again for 1 set of 10 repetitions. Patients will be required to complete these home-exercises two to three times daily, lasting for approximately 30 minutes up until the 6-week time point. At the 6-week time-point, after the patients a reviewed by their surgeon and have their immobilisation sling removed, patients in each both groups will have their exercises progressed accordingly, to include active-assisted exercises using a pulley, and a wall to assist with elevation, consistent with standard practice. In addition, the DARE group will undertake exercises aimed at improving external rotation using a Thera-band, and active elevation exercises starting supine and progressing (managed by the patient themselves) gradually into upright as tolerated. Each exercise will be prescribed for 2 sets of 10-15 repetitions, unless modified at the discretion of the Exercise Physiologist, or the treating surgeon. Patients will be required to complete these home-exercises twice daily, lasting for approximately 30 minutes up until the 12-week time point. Patients will all receive a “post-surgery home exercise guide” as a reference, but also acting as a patient diary to record all exercises done over the 12 weeks. All patients will continue to be monitored throughout the post-surgery timeline, irrespective of the group they have been assigned. At 12-weeks post-surgery, patients randomised to the DARE group will be referred to the Clinic (HFRC), to begin an 8-week supervised, strengthening exercise program, consisting of 30 to 60-minute sessions, once or twice per week. This program of intensified strength and conditioning will look to advance deltoid and internal, and external rotator strength to improve functional elevation & active rotation, as well as scapula stability training and cardiovascular exercise under the supervision of an Exercise Physiologist. Patients will also be required to complete daily home exercises, which will again be referenced in the “post-surgery home exercise guide.”