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Conservative treatment of rotator cuff tear in older patients: a role for the cycloergometer? A randomized study [with consumer summary]
Gialanella B, Comini L, Gaiani M, Olivares A, Scalvini S
European Journal of Physical and Rehabilitation Medicine 2018 Dec;54(6):900-910
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: To date, there are no published data on the use of devices in the management of rotator cuff tear (RCT). AIM: The aim of this study was to evaluate the effect of supervised arm cycloergometer training on pain during activities and shoulder functionality in patients with symptomatic full-thickness RCT. DESIGN: This is a prospective randomized controlled pilot study. SETTING: Outpatients of our Rehabilitation Unit. POPULATION: In this pilot study, 40 elderly outpatients (> 70 years) with RCT were randomized to two groups: cycloergometer (CYC) versus control patients. METHODS: All patients underwent a common outpatient rehabilitation exercise program consisting of ten 30-min sessions (5 sessions/week). At discharge, CYC patients received 15-min training with an arm cycloergometer and were invited to use the cycloergometer at home 20 min/twice a day. Control patients were invited to continue the standard exercises. During the 6-month study period CYC patients, but not control patients, received educational reinforcement monthly from the nurse of the telemedicine service. Outcomes assessed, between admission (T0) and 6-month follow-up (T6), were: pre to postpain during activities, active and passive ROMsum, ROM-painsum, revised Constant Total Score, and Health Assessment Questionnaire (HAQ). RESULTS: At T6, CYC patients showed a significant improvement in all outcome measures with respect to T0 (all p < 0.001). CYC patients showed also significant improvement in passive forward elevation, abduction, and external rotation of shoulder, as well as in active ROMsum and ROM-painsum in all single shoulder movements, and significant improvement in the HAQ items: dressing/grooming, eating, hygiene, reach, and common daily activities. At T6 the CYC group had lower pain during activities (p < 0.01) and higher revised constant total score (p < 0.01), ROM-painsum (p < 0.05) and active ROMsum (p < 0.05) than control patients. Home cycloergometer use was inversely associated to pain during activities (p < 0.01) and revised Constant Total Score (p < 0.01) at T6. CONCLUSIONS: A short program of shoulder passive exercises and cuff strengthening exercises followed by regular use of the cycloergometer for 6 months at home can reduce pain and improve shoulder functionality in RCT patients.

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