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

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

*Corresponding author for this work

Research output: Contribution to journalArticle (journal)peer-review

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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.

Original languageEnglish
Article number102874
Pages (from-to)1-7
Number of pages7
JournalMusculoskeletal Science and Practice
Volume68
Early online date30 Oct 2023
DOIs
Publication statusPublished - 1 Nov 2023

Keywords

  • Randomised controlled trial
  • Rehabilitation
  • Rotator cuff
  • Rotator Cuff/surgery
  • Pilot Projects
  • Multicenter Studies as Topic
  • Humans
  • England
  • Adult
  • Waiting Lists
  • Physical Therapists

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