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Updated: Jul 5, 2025
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised
Rebecca S Kearney1, David R Ellard2, Helen Parsons2
1Bristol Trials Centre, University of Bristol, Bristol, UK Becky.Kearney@Bristol.ac.uk.
Objective:
To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.
Design:
Pragmatic, multicentre, randomised controlled trial (ARTISAN).
Setting And Participants:
Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.
Interventions:
One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.
Main Outcome Measures:
The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.
Results:
482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).
Conclusions:
An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.
Trial Registration:
Current Controlled Trials ISRCTN63184243.
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