Physiotherapist-led exercise versus usual care (waiting-list) control for patients awaiting rotator cuff repair surgery: A pilot randomised controlled trial (POWER)

Littlewood, Chris; Moffatt, Maria; Beckhelling, Jacqueline; Davis, Daniel; Burden, Adrian; Pitt, Lisa; Lalande, Stacey; Maddocks, Catrin; Stephens, Gareth; Tunnicliffe, Helen; Pawson, Jessica; Lloyd, James; Manca, Andrea; Wade, Julia; E. Foster, Nadine

Abstract

Background: Once a decision to undergo rotator cuff repair surgery is made, patients are placed on the waiting list. It can take weeks or months to receive surgery. There has been a call to move from waiting lists to 'preparation' lists to better prepare patients for surgery and to ensure it remains an appropriate treatment option for them.

Objective: To evaluate the feasibility, as measured by recruitment rates, treatment fidelity and follow-up rates, of a future multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of undertaking a physiotherapist-led exercise programme while waiting for surgery versus usual care (waiting-list control).

Design: Two-arm, multi-centre pilot randomised controlled trial with feasibility objectives in six NHS hospitals in England. Method: Adults (n = 76) awaiting rotator cuff repair surgery were recruited and randomly allocated to a programme of physiotherapist-led exercise (n = 38) or usual care control (n = 38).

Results: Of 302 eligible patients, 76 (25%) were randomised. Of 38 participants randomised to physiotherapist-led exercise, 28 (74%) received the exercise programme as intended. 51/76 (67%) Shoulder Pain and Disability Index questionnaires were returned at 6-months. Of 76 participants, 32 had not received surgery after 6-months (42%). Of those 32, 20 were allocated to physiotherapist-led exercise; 12 to usual care control.

Conclusions: A future multi-centre randomised controlled trial is feasible but would require planning for variable recruitment rates between sites, measures to improve treatment fidelity and opportunity for surgical exit, and optimisation of follow-up. A fully powered, randomised controlled trial is now needed to robustly inform clinical decision-making.

• Journal Article Type: Article
• Acceptance Date: Oct 19, 2023
• Online Publication Date: Oct 30, 2023
• Publication Date: Nov 3, 2023
• Deposit Date: Nov 15, 2024
• Publicly Available Date: Nov 15, 2024
• Journal: Musculoskeletal Science and Practice
• Print ISSN: 2468-7812
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 68
• Article Number: 102874
• DOI: https://doi.org/10.1016/j.msksp.2023.102874
• Keywords: Randomised controlled trial, Rehabilitation, Rotator cuff, Rotator Cuff/surgery, Pilot Projects, Multicenter Studies as Topic, Humans, England, Adult, Waiting Lists, Physical Therapists