Variability in physical therapy protocols following total shoulder arthroplasty.

Area of Science:

• Orthopedics
• Physical Therapy
• Rehabilitation Medicine

Background:

• Physical therapy (PT) is crucial for functional recovery after anatomic total shoulder arthroplasty (aTSA).
• Current PT protocols for aTSA lack standardization, potentially causing confusion and suboptimal patient outcomes.
• This study investigates variations in PT protocols from academic orthopedic surgery programs for aTSA rehabilitation.

Purpose of the Study:

• To analyze and compare physical therapy (PT) protocols for anatomic total shoulder arthroplasty (aTSA) rehabilitation.
• To identify inconsistencies in therapeutic goals and activity recommendations among different PT protocols.
• To highlight the lack of standardization in aTSA recovery guidelines.

Main Methods:

• Reviewed publicly available PT protocols from 175 Accreditation Council for Graduate Medical Education-accredited orthopedic surgery programs.
• Analyzed protocols for variations in immobilization duration, range of motion (ROM) goals, exercise progression, and return-to-activity timelines.
• Assessed 25 protocols (14.2%) for differences in rehabilitation recommendations.

Main Results:

• Most protocols recommended an average of 4.4 weeks of sling immobilization.
• Significant variability observed in recommended start times for active range of motion (AROM) exercises (1-7 weeks).
• Inconsistent goals for passive and active ROM, resistance exercise initiation, and return to recreational activities (average 17.4 weeks).

Conclusions:

• Publicly accessible physical therapy protocols for aTSA rehabilitation demonstrate considerable variability.
• The lack of standardized guidelines presents challenges for consistent patient care and outcomes.
• Further research is needed to establish evidence-based, standardized rehabilitation protocols for aTSA.