Home-based physical therapy results in similar outcomes to formal outpatient physical therapy after reverse total shoulder arthroplasty: a randomized controlled trial

Abstract

Background: Outcomes following reverse total shoulder arthroplasty (RTSA) are influenced by surgical indications, surgical technique, implant design, and patient variables. The role of self-directed postoperative physical therapy after RTSA is poorly understood. The purpose of this study was to compare the functional and patient-reported outcomes (PROs) of a formal physical therapy (F-PT) program vs. a home therapy program after RTSA.

Methods: One hundred patients were prospectively randomized into 2 groups: F-PT and home-based physical therapy (H-PT). Patient demographic variables, range of motion (ROM) and strength measurements, and outcomes (Simple Shoulder Test, American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale, and Patient Health Questionnaire-2 scores) were collected preoperatively and at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Patient perceptions regarding their group assignment, F-PT vs. H-PT, were also assessed.

Results: Seventy 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. The average length of 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 by 0.8 kilograms-force (kgf) with F-PT (P = .04). PROs at final follow-up did not differ between therapy groups. Patients receiving home-based therapy appreciated the convenience and cost savings, and the majority believed home therapy was less burdensome.

Conclusion: Formal physical therapy and home-based physical therapy programs after RTSA result in similar improvements in ROM, strength, and PRO scores.

Keywords: Physical therapy; anatomic total shoulder arthroplasty; cost of health care; home-based physical therapy; outcomes; reverse total shoulder arthroplasty.