[Disability and occupational therapy in patient with tear of the rotator cuff]

The aim of the study was to evaluate the disability of patients with tear of the rotator cuff (TRC) in order to propose an occupational therapy program.

We studied 54 patients with TRC. All patients were women (average age 75.4 +/- 5.6 years). X-ray and Ultrasonography were performed on all patients, while Magnetic Resonance Imaging only on 8. The assessment was made using the Constant Scale, the Groningen Activity Restriction Scale, the Health Assessment Questionnaire (HAQ), and shoulder range of motion.

According to HAQ, disability was severe in 33.4% of patients, moderate in 51.9%, slight in 12.9% and absent in 1.8%. Active motion of shoulder played a relevant role in determining disability (beta = -0.57, p = 0.000, R2 = 0.54), and the active flexion was the most powerful prognostic factor positively associated with disability (beta = 0.50, p = 0.000, R2 = 0.37). Disability was higher in patients with severe deficit of active flexion (z = -3.401, p = 0.000). In patients with bilateral TRC disability was higher than that of patients with right TRC (p = 0.008). Disability did not differ between left and bilateral TRC and between right and left TRC. In patient with bilateral TRC disability was severe in 46.7% of cases and moderate in 53.3%.

Our data show that the TRC causes moderate-severe disability and that disability is related to active flexion. In the light of these data we proposed an occupational therapy program. The main points of this program are the gestural compensation, the use of substitutive mechanical aids and the adjustment of the patient's dwelling.