ROTATOR CUFF DISORDERS: A SURVEY OF CURRENT PHYSIOTHERAPY PRACTICE IN TURKIYE

Year 2023, Volume: 34 Issue: 3, 346 - 356, 19.12.2023

Bahar Ayberk Bahar Özgül Julie Bury Mine Gülden Polat

https://doi.org/10.21653/tjpr.1233425

Abstract

Purpose: One of the most important factors guiding the physiotherapy program for rotator cuff disorders (RCD) is the clinical preferences of the physiotherapist in light of the evidence. However, the management parameters are remarkably variable between physiotherapists. It was aimed to describe the current physiotherapy practice of Turkish physiotherapists for the management of RCD and to explore its parallelism with the research evidence, and with the clinical perspective in European countries.
Methods: A cross-sectional online survey based on a clinical scenario that describes a typical patient with symptoms of RCD was conducted during July/August 2020. Descriptive responses of 104 physiotherapists were reported and analyzed by grouping physiotherapists with special interest (SI) who have further clinical experience or specialized training on RCD and no special interest (NSI).
Results: The most preferred approaches were mobilization (82), scapular stabilization exercises (82), advice/education (71), and taping (62). The preference rate of cold therapy (χ2=4.303, p=0.038) and isometric exercises (χ2=4.248, p=0.039) were significantly higher for physiotherapists with SI rather than NSI group.
Conclusions: The most preferred management strategies of mobilization, exercise, and advice/education have been aligned with the preferences of physiotherapists from European countries and the current research evidence. However, passive modalities were also highly preferred. The management strategies differ between the physiotherapists who have SI and NSI. The high degree of practice variability and passive treatment preference of physiotherapists for the patients with RCD might be due to a lack of following the current literature evidence regularly.

Keywords

Rotator Cuff, Shoulder, Survey/s

ROTATOR MANŞET PATOLOJİLERİ: TÜRKİYE’DE MEVCUT FİZYOTERAPİ UYGULAMALARI

Abstract

Amaç: Rotator manşet patolojilerinde (RMP) fizyoterapi programına yön veren en önemli faktörlerden biri, bilimsel kanıtlar ışığında fizyoterapistin klinik tercihleridir. Bununla birlikte yönetim parametreleri fizyoterapistler arasında oldukça değişkendir. Bu çalışmada Türk fizyoterapistlerin RMP tedavisi için kullandıkları mevcut fizyoterapi uygulamalarının tanımlanması ve bu uygulamaların literatür kanıtları ve Avrupa ülkelerindeki klinik bakış açısı ile paralelliğinin incelenmesi amaçlandı.
Yöntem: RMP semptomları olan tipik bir hastayı tanımlayan bir klinik senaryoya dayalı kesitsel bir online anket Temmuz/Ağustos 2020 tarihleri arasında uygulandı. Yüz dört fizyoterapistin tanımlayıcı yanıtları, RMP ile ilgili daha fazla klinik deneyime veya eğitime sahip olan (SI) ve olmayan fizyoterapistler (NSI) olarak iki gruba ayrılarak raporlandı ve analiz edildi.
Sonuçlar: En çok tercih edilen yaklaşımlar mobilizasyon (82), skapular stabilizasyon egzersizleri (82), tavsiye/eğitim (71) ve bantlamaydı (62). Soğuk uygulama (χ2=4,303, p=0,038) ve izometrik egzersiz (χ2=4,248, p=0,039) tercih oranı SI grubundaki fizyoterapistler için NSI grubuna göre anlamlı olarak yüksekti.
Tartışma: En çok tercih edilen yönetim stratejileri olan mobilizasyon, egzersiz ve tavsiye/eğitim Avrupa ülkelerindeki fizyoterapistlerin tercihleri ve güncel literatür kanıtlarıyla uyumlu olarak bulundu. Ancak pasif modaliteler de yüksek oranda tercih edilmişti ve SI ve NSI gruplarındaki fizyoterapistlerin yönetim stratejileri de farklılık gösteriyordu. RMP hastaları için fizyoterapistler arasındaki yüksek oranda uygulama değişkenliği ve pasif tedavi tercihi, güncel literatür kanıtlarının düzenli olarak takip edilmemesine bağlı olabilir.

Keywords

Rotator Manşet, Omuz, Anket

References

• Pope DP, Croft PR, Pritchard CM, Silman AJ. Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis. 1997;56(5):308–12.
• Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, Pan Y, Charles J, Pollack AJ, Chambers T, Gordon J, Wong C. A decade of Australian general practice activity 2006–07 to 2015–16. General practice series no. 41. Sydney: Sydney University Press; 2016.
• Ottenheijm RP, Joore MA, Walenkamp GH, Weijers RE, Winkens B, Cals JW, de Bie RA, Dinant GJ. The Maastricht Ultrasound Shoulder pain trial (MUST): ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care. BMC Musculoskelet Disord. 2011;8(12):154.
• Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73–81.
• Linsell L, Dawson J, Zondervan K, Rose P, Randall T, Fitzpatrick R, et al. Prevalence and incidence of adults consulting for shoulder conditions in UK primary care; patterns of diagnosis and referral. Rheumatology (Oxford). 2006;45(2):215–21.
• Winters JC, Sobel JS, Groenier KH, Arendzen JH, Meyboom-de Jong B. The long-term course of shoulder complaints: a prospective study in general practice. Br J Rheumatol. 1999;38(2):160–3.
• Chaudhury S, Gwilym SE, Moser J, Carr AJ. Surgical options for patients with shoulder pain. Nat Rev Rheumatol. 2010;6(4):217–26.
• Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004;17(2):152–64.
• Dorrestijn O, Stevens M, Diercks RL, van der Meer K, Winters JC. A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord. 2007;8(1):1–8.
• Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138–60.
• Hallgren HC, Holmgren T, Oberg B, Johansson K, Adolfsson LE. A specific exercise strategy reduced the need for surgery in subacromial pain patients. Br J Sports Med. 2014;48(19):1431–6.
• Littlewood C, Malliaras P, Chance-Larsen K. Therapeutic exercise for rotator cuff tendinopathy: a systematic review of contextual factors and prescription parameters. Int J Rehabil Res. 2015;38(2):95–106.
• Pieters L, Lewis J, Kuppens K, Jochems J, Bruijstens T, Joossens L, et al. An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain. J Orthop Sports Phys Ther. 2020;50(3):131–41.
• Paraskevopoulos E, Plakoutsis G, Chronopoulos E, Maria P. Effectiveness of Combined Program of Manual Therapy and Exercise Vs Exercise Only in Patients With Rotator Cuff-related Shoulder Pain: A Systematic Review and Meta-analysis. Sports Health. Sports Health. 2022;19417381221136104.
• Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340–7.
• de Oliveira FC, Pairot de Fontenay B, Bouyer LJ, Desmeules F, Roy JS. Kinesiotaping for the Rehabilitation of Rotator Cuff-Related Shoulder Pain: A Randomized Clinical Trial. Sports Health. 2021;13(2):161–72.
• Celik D, Karaborklu Argut S, Coban O, Eren I. The clinical efficacy of kinesio taping in shoulder disorders: a systematic review and meta-analysis. Clin Rehabil. 2020 Jun;34(6):723-740.
• Ghozy S, Dung NM, Morra ME, Morsy S, Elsayed GG, Tran L, Minh LHN, Abbas AS, Loc TTH, Hieu TH, Dung TC, Huy NT. Efficacy of kinesio taping in treatment of shoulder pain and disability: a systematic review and meta-analysis of randomised controlled trials. Physiotherapy. 2020;107:176-188.
• Littlewood C, Lowe A, Moore J. Rotator cuff disorders: a survey of current UK physiotherapy practice. Shoulder Elbow. 2012;4(1):64–71.
• Bury J, Littlewood C. Rotator cuff disorders: a survey of current (2016) UK physiotherapy practice. Shoulder Elbow. 2018;10(1):52–61.
• Pieters L, Voogt L, Bury J, Littlewood C, Feijen S, Cavaggion C, et al. Rotator CUFF disorders: A survey of current physiotherapy practice in Belgium and the Netherlands. Musculoskelet Sci Pract. 2019;43:45–51.
• Brindisino F, Matteuzzi I, Bury J, McCreesh K, Littlewood C. Rotator cuff disorders: a survey of current (2018) Italian physiotherapy practice. Physiother Pract Res. 2020;41(1):11–22.
• Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord. 2011;12(1):119.
• Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–78.
• Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al.; Association Dutch Orthopaedic. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314–22.
• Bouju Y, Bouilleau L, Dubois de Montmarin G, Bacle G, Favard L. Do subacromial ultrasonography findings predict efficacy of intra-bursal injection? Prospective study in 39 patients. Orthop Traumatol Surg Res. 2014;100(8):361–4.
• Barreto RP, Braman JP, Ludewig PM, Ribeiro LP, Camargo PR. Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. J Shoulder Elbow Surg. 2019;28(9):1699–706.
• Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer E, Roy JS, Dyer JO, et al. Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations. Arch Phys Med Rehabil. 2020;101(7):1233–42.
• Bury TJ, Stokes EK. Direct access and patient/client self-referral to physiotherapy: a review of contemporary practice within the European Union. Physiotherapy. 2013;99(4):285–91.
• Bury J, West M, Chamorro-Moriana G, Littlewood C. Effectiveness of scapula-focused approaches in patients with rotator cuff related shoulder pain: a systematic review and meta-analysis. Man Ther. 2016;25:35–42.
• Haik MN, Alburquerque-Sendin F, Moreira RF, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016;50(18):1124–34.
• Saito H, Harrold ME, Cavalheri V, McKenna L. Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: A systematic review and meta-analysis. Physiother Theory Pract. 2018;34(9):653–70.
• Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the ‘Scapular Summit’. Br J Sports Med. 2013;47(14):877–85.
• Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003;11(2):142–51
• Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009;39(2):90–104.
• Hoeger Bement MK, Dicapo J, Rasiarmos R, Hunter SK. Dose response of isometric contractions on pain perception in healthy adults. Med Sci Sports Exerc. 2008;40(11):1880–9.
• Lemley KJ, Drewek B, Hunter SK, Hoeger Bement MK. Pain relief after isometric exercise is not task-dependent in older men and women. Med Sci Sports Exerc. 2014;46(1):185–91.
• Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–83.
• Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1679–87.