Scientific/Clinical ArticlesThe effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review
Section snippets
Methods
A primary literature search of computerized bibliographic databases was conducted with an English-only language restriction and a date restriction of articles published January 1980 up to and including April 2003. The databases chosen were Medline, the Cumulative Index to Nursing & Allied Health (CINAHL), DARE, AMED, PubMed, and Cochrane. Search terms used included shoulder, shoulder joint, instability, dislocation, subluxation, treatment, rehabilitation, exercise therapy, physiotherapy,
Results
Table 1 lists the consensus scores of methodological quality for each of the 19 articles meeting the inclusion criteria. Table 1 describes 24 specific research design elements of the studies appraised whereby a score of 2 represents the best score and indicates a high-quality approach to this element of research design. A score of 1, in turn, represents fair quality or that the methodological criteria were only partially met, whereas a score of 0 represents low-quality research design or unmet
Disease-specific quality of life
One high-quality RCT included the validated Western Ontario Shoulder Instability Index (WOSI) as an outcome measure to assess disease-specific quality of life in 40 skeletally mature patients under the age of 30 years who had previously sustained a first traumatic anterior shoulder dislocation.24 The results showed that three weeks' immobilization followed by a rehabilitation protocol is less effective than arthroscopic surgery followed by the same protocol for improving quality of life.24
Patient satisfaction
One
Reviewers' conclusions and recommendations
Although there are numerous protocols for the conservative management of traumatic or atraumatic shoulder instability published in scientific journals, the majority are based only on physiological rationale and biological evidence rather than on specific clinical trials. This reflects the paucity of such evidence, with the few primary research articles published since 1980 consisting of generally low methodological quality. A conservative inclusion criteria threshold score of 18 on the standard
Limitations of the review
The current review is limited by a paucity of primary evidence in the literature pertaining to conservative management strategies for shoulder instability. Generally, the methodological quality of these studies is quite low, and many fail to provide sufficient descriptions of conservative treatment protocols. This weakness limits both the strength and clarity of our conclusions. However, it should be noted that the quality of some studies may have been underestimated by the critical appraisal
Clinical practice recommendations
The results of this review are summarized to assist practitioners and therapists in clinical decision making when treating patients with shoulder instability. Although the present evidence is weak, the current best evidence suggests that: (1) Immobilization for three to four weeks followed by a structured 12-week rehabilitation program of range-of-motion and glenohumeral and scapular stability exercises is recommended for patients with primary dislocations to maximize return to premorbid
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Use and psychometric properties of the Reintegration to Normal Living Index in rehabilitation: A systematic review
2018, Annals of Physical and Rehabilitation MedicineKinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications
2018, Annals of Physical and Rehabilitation MedicineCitation Excerpt :However, evaluating the real effects is difficult because of the large heterogeneity and low quality of the studies included as well as the poor definition of the exercise protocols [40]. For patients with anterior primary dislocation, a program of immobilization for 3 to 4 weeks followed by a structured 12-week rehabilitation program, including RoM and GH and scapular stability exercises, is recommended to maximize a return to premorbid activity levels [60]. When dyskinesis is associated with joint derangement factors or “internal impingement” (including labral injury, GH instability, biceps tendinitis), exercise prescription should be based on a clinical reasoning process during the physical examination as well as the specific characteristics and demands of the sport for athletes.
Shoulder Instability Treatment and Rehabilitation
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2016, Pathology and Intervention in Musculoskeletal RehabilitationMotions and functional performance after supervised physical therapy program versus home-based program after arthroscopic anterior shoulder stabilization: A randomized clinical trial
2014, Annals of Physical and Rehabilitation MedicineCitation Excerpt :This was for fear of patient may exceed the permitted range as pain after arthroscopy was relatively low [20]. Following shoulder instability surgeries, Gibson et al. [21] recommended immobilization of patient's arm when passive ROM exceeds 90% and the joint end feel is elastic. One of the ultimate goals after arthroscopic anterior shoulder stabilization is to gradually achieve full active ROM in order not to interfere with the healing process [21].
Movement control in patients with shoulder instability: A comparison between patients after open surgery and nonoperated patients
2014, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Although such a hypothetical strategy would not require the use of feedback, it would certainly lead to less adaptation to ever-changing conditions. Thus, whereas therapeutic recovery of function may be an important part of postoperative treatment, this may not be sufficient.15,19 Recovery should be accompanied by a change in movement strategy with a focus on a change from a feedforward mode of control to a feedback-based mode of control.