The effectiveness of 12 months' intensive shoulder strength training on disability, health-related quality of life and shoulder function after rotator cuff repair

Abstract

This study examined the effectiveness of intensive shoulder strength training on disability, health-related quality of life (HRQoL) and shoulder function in patients who had undergone rotator cuff repair (RCR). In addition, the self- report section of the American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES) was cross-culturally adapted to the Finnish language and the psychometric properties of the Finnish version were assessed. Patients with a rotator cuff tear (aged 41-62 years) were randomized into an exercise group (EG, n=35) or a usual care group (UCG, n=32) after RCR. Disability was assessed with ASES questionnaire and quality of life with Short- Form 36 Health Survey (SF-36) preoperatively and at two months, 12 months and three years after surgery. Shoulder function was evaluated by measuring range of motion (ROM) and muscle strength at two and 12 months after surgery. The strength training intervention began two months after surgery and lasted 12 months. The EG were given instructions on a home-based shoulder muscle strengthening programme, while the UCG received ordinary postoperative instructions. The reliability of the ASES questionnaire was assessed. Preoperatively, the RCR patients with high functional disability of the shoulder demonstrated low HRQoL. After the 12-month intervention, no between-group differences were observed in any of the outcomes. The mean (SD) ASES score improved from 74 (14) by 21 points (95% CI, 16 to 26, p < 0.001) in the EG and from 70 (18) by 25 points (95% CI, 20 to 31, p < 0.001) in the UCG. Both groups maintained their post-intervention ASES score levels throughout the three-year follow-up. The Finnish version of the ASES proved to be a reliable and valid shoulder-specific measurement tool. These results suggest that the majority of the patients achieved good re- covery during one year. The additional exercise intervention did not benefit patients with a rotator cuff tear.