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Advice only versus advice and a physiotherapy programme for acute traumatic anterior shoulder dislocation: the
Rebecca Kearney1, David Ellard2,3, Helen Parsons2,3
1Bristol Trials Centre, University of Bristol, Bristol, UK.
Summary
Physiotherapy following shoulder dislocation offers little benefit over advice alone, but is likely cost-effective. Further research should optimize self-management strategies for patients with traumatic shoulder dislocation.
Area of Science:
- Orthopedics
- Sports Medicine
- Rehabilitation
Background:
- The benefit of physiotherapy post-traumatic shoulder dislocation is uncertain.
- This study compares advice alone versus advice plus physiotherapy.
Purpose of the Study:
- To compare clinical and cost-effectiveness of physiotherapy alongside advice for first-time traumatic shoulder dislocation.
- Primary objective: assess Oxford Shoulder Instability Score differences at 6 months.
Main Methods:
- Pragmatic, multicentre, superiority, randomised controlled trial.
- Adults with first-time traumatic anterior shoulder dislocation managed non-operatively.
- Intervention: advice plus physiotherapy; Control: advice only.
Main Results:
- No statistically significant difference in Oxford Shoulder Instability Score at 6 months.
- Physiotherapy was likely cost-effective (95% probability at £30,000 threshold).
- Small, imprecise incremental costs and QALYs were observed.
Conclusions:
- Little difference in outcomes between advice and physiotherapy plus advice.
- Physiotherapy is likely cost-effective but questions remain about resource allocation.
- Further research should focus on optimizing self-management strategies.
