INTRODUCTION: Outcomes following reverse total shoulder (RTSA) arthroplasty are influenced by surgical indications, surgical technique, implant design and patient variables. The role of self-directed postoperative physical therapy (PT) is poorly understood following RTSA. The purpose of this study was to compare the functional and patient reported outcomes (PRO) of a formal physical therapy program to a home therapy program after undergoing a reverse total shoulder arthroplasty. METHODS: One hundred patients were prospectively randomized into two groups: formal PT (F-PT) and home-based PT (H-PT). Patient demographic variables along with range of motion (ROM), strength measurements and SST, ASES, SANE, VAS, PHQ-2 outcomes were collected preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Patient perceptions regarding their individual group, F-PT versus H-PT, were also assessed. RESULTS: Sixty-eight patients were included for analysis with 37 in the H-PT group and 33 in the F-PT group. Thirty patients in both groups had a minimum of 6 months follow-up. Average follow-up was 20.8 months. Forward flexion, abduction, internal rotation and external rotation ROM did not differ between groups at final follow-up. Strength did not differ between groups with the exception of external rotation, which was greater with formal physical therapy by 0.8 kg/f (p = 0.04). PRO at final follow-up did not differ between therapy groups. Patients receiving home-based therapy appreciated the convenience and cost-savings and the majority felt this was less burdensome. CONCLUSION: Formal physical therapy and home-based physical therapy programs after reverse shoulder arthroplasty result in similar improvements in range of motion, strength, and PRO scores. LEVEL OF EVIDENCE: Level I; Randomized Controlled Trial; Treatment Study.

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