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Physiotherapist-led exercise versus usual care (waiting-list) control for patients awaiting rotator cuff repair surgery: A pilot randomised controlled trial (POWER).

Littlewood, Chris; Moffatt, Maria; Beckhelling, Jacqueline; Davis, Daniel; Burden, Adrian; Pitt, Lisa; Lalande, Stacey; Maddocks, Catrin; Stephens, Gareth; Tunnicliffe, Helen; Pawson, Jessica; Lloyd, James; Manca, Andrea; Wade, Julia; Foster, Nadine E

Authors

Chris Littlewood

Maria Moffatt

Jacqueline Beckhelling

Daniel Davis

Adrian Burden

Lisa Pitt

Stacey Lalande

Catrin Maddocks

Gareth Stephens

Helen Tunnicliffe

Jessica Pawson

James Lloyd

Andrea Manca

Julia Wade

Nadine E Foster



Abstract

Once a decision to undergo rotator cuff repair surgery is made, patients are placed on the waiting list. It can take weeks or months to receive surgery. There has been a call to move from waiting lists to 'preparation' lists to better prepare patients for surgery and to ensure it remains an appropriate treatment option for them. To evaluate the feasibility, as measured by recruitment rates, treatment fidelity and follow-up rates, of a future multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of undertaking a physiotherapist-led exercise programme while waiting for surgery versus usual care (waiting-list control). Two-arm, multi-centre pilot randomised controlled trial with feasibility objectives in six NHS hospitals in England. Adults (n = 76) awaiting rotator cuff repair surgery were recruited and randomly allocated to a programme of physiotherapist-led exercise (n = 38) or usual care control (n = 38). Of 302 eligible patients, 76 (25%) were randomised. Of 38 participants randomised to physiotherapist-led exercise, 28 (74%) received the exercise programme as intended. 51/76 (67%) Shoulder Pain and Disability Index questionnaires were returned at 6-months. Of 76 participants, 32 had not received surgery after 6-months (42%). Of those 32, 20 were allocated to physiotherapist-led exercise; 12 to usual care control. A future multi-centre randomised controlled trial is feasible but would require planning for variable recruitment rates between sites, measures to improve treatment fidelity and opportunity for surgical exit, and optimisation of follow-up. A fully powered, randomised controlled trial is now needed to robustly inform clinical decision-making. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.]

Journal Article Type Article
Acceptance Date Oct 19, 2023
Online Publication Date Oct 30, 2023
Deposit Date Nov 27, 2023
Journal Musculoskeletal science & practice
Print ISSN 2468-7812
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 68
Article Number 102874
DOI https://doi.org/10.1016/j.msksp.2023.102874
Keywords Rotator cuff, Rehabilitation, Randomised controlled trial