PRE-OPERATIVE PHYSICAL THERAPY
In the absence of reliable evidence, it is the opinion of the work group that physical therapy may benefit select patients with glenohumeral joint osteoarthritis

Rationale

One low quality case series (Chinese) reported on multimodal treatment including PT, NSAIDs, injections (cortisone and/or sodium hyaluronate), and education at the discretion of the treating physician. N = 129; at 3 months alone PT not effective so added a multi-modal treatment approach. 84 /86 received rehabilitation/formalized PT services added to other interventions and 69% found the PT component to be helpful.

Initial improvement at 3 months after multi-modal intervention, then worsening, then better at 12 months which was sustained at 36 months.  Outcomes assessed included VAS, SST, SF-36.

Expert opinion from book chapter by Patrick St. Pierre and Mark Frankle: “Shoulder Rehabilitation:  Is there a role for home therapy?”  In: Physical Therapy: Theories, Practices and Benefits, ISBN: 978-1-61122-418-4, Editor: James P. Bennett ©2011 Nova Science Publishers, Inc. “Formal PT is used in most patients before surgery is considered, and often is effective in decreasing pain, restoring function, and obviating the need for surgical intervention.”

The workgroup discussed that young patients with GJO who are not good candidates for arthroplasty due to concerns for implant survivorship, and older patients who are not surgical candidates due to co-morbidities may benefit from physical therapy to aid in optimizing mobility and function, and minimizing pain.

 

Strength of Evidence (evidence quality): No reliable evidence

 

Benefits & Harms:
Physical therapy may be beneficial for shoulder patients to improve mobility, strength and function for patients with GJO.  Overzealous therapy may increase pain in this population.  Benefits may be appreciated over a long course of care and may be of a greater advantage to patients who are not candidates for shoulder arthroplasty.
 

Cost Effectiveness/Resource Utilization:
Therapy services pose an expense to third party payers as well as to patients for deductibles/copayments.  Often there is a visit limit for rehabilitation services therefore if surgery is being considered, therapy may best be reserved for post-operative rehabilitation needs.

 

Future Research:
The efficacy of formal physical therapy for GJO needs to be studied in a more systematic fashion with long term follow up.

 

Additional References:  

Guo, J.J., Wu, K., Guan, H., et. al. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients. Orthopedics. 2016;39(4):e634-41.

St. Pierre, P., & Frankle, M. (2011). Shoulder Rehabilitation:  Is there a role for home therapy? In J.P. Bennet (Ed) Physical Therapy: Theories, Practices and Benefits. Hauppauge, NY: Nova Science Publishers, Inc.


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