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Effects of different postoperative rehabilitation approaches following shoulder arthroplasty: A systematic review and
Jiahui Zou1, Yihong Shi2, Andréas Remis3
1School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China.
Background:
The optimal postoperative rehabilitation protocol after shoulder arthroplasty remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the effectiveness of different rehabilitation interventions.
Methods:
Two reviewers independently screened studies, extracted data, and assessed risk of bias using the PEDro scale and RoB 2 tool. Meta-analysis was performed with a random-effects model.
Results:
Nine RCTs (793 patients) were included; PEDro scores ranged from 5 to 8. In reverse total shoulder arthroplasty (rTSA), home-based rehabilitation was non-inferior to outpatient physical therapy for range of motion, patient-reported outcomes, and pain at 1 year. Early mobilization improved forward flexion at 3 months, but this difference was no longer evident at 6 months; in one anatomic TSA trial, it was associated with a trend toward lower lesser tuberosity healing. Subscapularis-specific training did not confer additional benefits.
Discussion:
Home-based or telerehabilitation is a safe, potentially cost-effective alternative after rTSA; limited evidence for anatomic TSA suggests similar trends. Early mobilization offers transient functional gains, and current evidence is insufficient to recommend subscapularis-specific training. These findings highlight the need for further high-quality trials, especially in anatomic TSA.