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Three Part Question

In [adult patients with rotator cuff repairs] does [the addition of hydrotherapy to standard physical treatment] improve [functional recovery]?

Clinical Scenario

A 24 year old man attends the Emergency Department having suffered an injury to his right shoulder whilst playing rugby. He has severely restricted movement. Plain x-ray shows no fracture. MR scan shows rotator cuff disruption. He is referred and subsequently undergoes operative repair. He is sent for rehabilitation post operatively. You wonder whether hydrotherapy will benefit him.

Search Strategy

Medline, Embase, Cinahl, AMED using the NHS Evidence with multifile searching May 13th 2011.
Pedro database http://www.pedro.org.au/ May update 2011. The Cochrane Library May 2011.


Multifile search:[exp Hydrotherapy/ OR hydrotherapy.ti,ab OR (aquatic AND therapy).ti,ab OR balneotherapy.ti,ab OR (water AND exercise).ti,ab OR (water AND rehabilitation).ti,ab ] AND [exp Rotator cuff/ OR exp Rotator cuff injuries/]

Pedro:[Therapy :Hydrotherapy, balneotherapy] AND [Body part: upper arm, shoulder, shoulder girdle]

Cochrane:MeSH descriptor hydrotherapy explode all trees AND MeSH descriptor rotator cuff explode all trees 1 record not relevant

Search Outcome

27 papers were retrieved of which one directly addressed the three part question. This paper is shown in the table below:

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Brady et al, 2008, Australia	18 consecutive adult patients following rotator cuff repair by a single surgeon. 12 treated with land and aquatic therapies vs 6 treated with land based therapies alone	Clinical trial	Passive range of movement	Forward flexion improved significantly at 3 weeks (p=0.005) and 6 weeks (p=0.01). No significant differences at 12 weeks	Not randomised. Small sample size. No mention of which rotator cuff muscles affected
			Western Ontario Rotator Cuff index	No statistical difference at 12 weeks

Comment(s)

One feasibility study looking into the use of hydrotherapy post rotator cuff repair was found. While the subjects were well matched and a good description of the intervention was documented treatments were allocated by the clinicians rather than randomly and numbers were very small. The study suggests hydrotherapy intervention may lead to significant changes in passive flexion at 3 and 6 weeks but showed no differences in any measured outcomes at 12 weeks. More studies with larger numbers are required to make definite recommendations.

Clinical Bottom Line

The addition of hydrotherapy to standard therapy for rotator cuff repairs may improve passive movement in the short term. Further research is needed.

References

1. Brady B, Redfern J, MacDougal G et al. The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study Physiother Res Int 2008;13:153-61.