Authors (including presenting author) :
Lee MHM(1), Ho WHA(2), Wong KHB(2), Leung WYF(1), Cheng CKJ(1)
Affiliation :
(1)Department of Occupational Therapy, Caritas Medical Centre, (2)Department of Orthopaedics & Traumatology, Caritas Medical Centre
Keyword 1: :
Recovery pattern
Keyword 2: :
Reverse total shoulder arthroplasty
Keyword 3: :
Occupational therapy
Keyword 4: :
Retrospective study
Introduction :
The indications for reverse total shoulder arthroplasty (RTSA) have expanded significantly due to its notable biomechanical advantages. Initially recommended for older patients with rotator cuff arthropathy, RTSA now includes cases of fractures, revision surgeries, and younger patients, accounting for over 70% of shoulder arthroplasties in the U.S. Research indicates rapid improvements in shoulder function, with recovery rates exceeding 70% at 12 weeks post-operation. There exists a notable evidence gap in local research regarding recovery pattern and functional outcomes during the early rehabilitation phase following RTSA. This gap is significant, as early postoperative results serve as crucial indicators of patient satisfaction with the surgical procedure.
Objectives :
This study aims to identify critical timeframes and assess anticipated improvements to guide rehabilitation strategies during the early phase, thereby establishing evidence-based functional goals for patients. It conducts a comparative analysis with recent meta-analyses to reinforce the efficacy of RTSA, particularly within a novel service model—Enhanced Allied Health Support (EAHS). Furthermore, this study investigates the influence of demographic factors on short-term outcomes.
Methodology :
A retrospective review was conducted of patients who underwent RTSA at Caritas Medical Centre from January 2020 to March 2025, all of whom received post-operative rehabilitation through the EAHS service. Improvements in pain scores, active and passive ROM for shoulder flexion, abduction, and external rotation and grip strength were analysed at 3, 6, and 12 weeks post-operation. The results for active ROM at 12 weeks post-operation, which marked the conclusion of the EAHS training, were compared with outcomes at the 2-year follow-up in a recent meta-analysis to calculate the recovery rate. The minimum clinically important difference (MCID) was employed to assess changes in DASH-HK scores between the initial and final EAHS sessions. Furthermore, predictive factors including sex, dominant side involvement, and preoperative diagnoses were evaluated to ascertain their impact on outcomes.
Result & Outcome :
A total of 20 patients were reviewed. Most measures of ROM exhibited highly statistically significant improvements over time (p < 0.001). The most substantial enhancement in active shoulder flexion occurred between 6 and 12 weeks, with a median increase of 35 degrees, rising from 65 degrees to 100 degrees (p < 0.001). Additionally, there was consistent progress in passive ROM with significant statistical changes occurring even early in the recovery process. By 12 weeks, recovery rates for active shoulder flexion and abduction were 74.6% and 79.7% respectively. The median improvement in the DASH-HK score for symptoms and disability was 28.15, demonstrating clinical significance as exceeded the MCID of 10 points. This study enabled the identification of targeted physical components essential for the appropriate grading of training activities, thereby establishing clear outcome expectations. It also offered comprehensive guidance for occupational therapists in facilitating patients' translation of physical improvements into functional performance. The reported accelerated recovery rates emphasized the necessity of early and intensive multidisciplinary postoperative rehabilitation. Furthermore, it highlighted the pivotal role of occupational therapy in empowering patients to actively engage in activities of daily living (ADLs) during the early phases of rehabilitation, enabling them to achieve and sustain self-directed improvements.
