Physiotherapist-led exercise versus usual care (waiting-list) control for patients awaiting rotator cuff repair surgery: A pilot randomised controlled trial (POWER)
Year: 2023
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
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.
Authors: 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
Institutions: Edge Hill University, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Airedale General Hospital, Airedale NHS Foundation Trust, Robert Jones and Agnes Hunt Orthopaedic Hospital, Royal Orthopaedic Hospital, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Barts Health NHS Trust, Royal London Hospital, University of York, University of Bristol, The University of Queensland, Metro North Hospital and Health Service
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,400
Awards: Surgery versus PhysiothErapist-leD exercise for traumatic tears of the rotator cuff: A multi-centre pilot and feasibility randomised controlled trial (SPeEDy), NIHR Senior Investigator Award, The MRC ConDuCT-II Hub. COllaboration and iNnovation in DiffiUlt and Complex randomised controlled Trials In Invasive procedures, NIHR Senior Investigator Award, HEE/NIHR ICA Pre-doctoral Clinical Academic Fellowship 2021
OpenAlex ID: W4388024276