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Review

Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis

1
Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy
2
Research Unit of Measurements and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy
3
Center for Advanced Orthopedic Studies, Carl J. Shapiro Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
4
Department of Orthopedic Surgery, Yerevan State Medical University, Yerevan 0025, Armenia
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(8), 2852; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082852
Received: 15 March 2020 / Revised: 14 April 2020 / Accepted: 16 April 2020 / Published: 21 April 2020
(This article belongs to the Special Issue New Frontiers in Rehabilitation)
Background: The objective of the present study was to compare the efficacy between supervised and unsupervised rehabilitation after rotator-cuff (RC) repair in terms of clinical outcomes, visual-analog-scale (VAS) score, range of motion (ROM), and risk of retear. Material: a comprehensive search of Pubmed, CINAHL, Cochrane, EMBASE, Ovid, and Google Scholar databases through a combination of the following keywords with logical Boolean operators: “informed”, “uninformed”, “unsupervised”, “supervised”, “rehabilitation”, “physical therapy”, “physical therapies”, “postoperative period”, “physical-therapy techniques”, “physical-therapy technique”, “exercise”, “exercise therapy”, “rotator cuff”, “rotator-cuff tear”, and “rotator-cuff repair”. For each article included in the study, the following data were extracted: authors, year, study design, sample size and demographic features, RC tear characteristics, clinical outcomes, ROM, VAS score, retear rate, and time of follow-up. Meta-analysis was performed in terms of VAS score. Results: Four randomized control trials with 132 patients were included. One study demonstrated significant improvement in VAS, active ROM, and the activity of the muscle’s motor units at stop and during maximal effort in supervised patients. Another one showed lower retear rates in the supervised group. The remaining two randomized controlled trials did not reveal any significant differences between supervised and unsupervised rehabilitation in terms of clinical outcomes. Moreover, higher costs were described for supervised rehabilitation. The VAS was not significantly different in the two groups (9.9 compared with 8.25, p = 0.23). Conclusions: although several publications address the problem of RC lacerations, there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocols. This systematic review and meta-analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores, while outlining the pros and cons of each protocol. View Full-Text
Keywords: supervised; unsupervised; exercise; cost analysis; rehabilitation; rotator cuff supervised; unsupervised; exercise; cost analysis; rehabilitation; rotator cuff
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MDPI and ACS Style

Longo, U.G.; Berton, A.; Risi Ambrogioni, L.; Lo Presti, D.; Carnevale, A.; Candela, V.; Stelitano, G.; Schena, E.; Nazarian, A.; Denaro, V. Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 2852. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082852

AMA Style

Longo UG, Berton A, Risi Ambrogioni L, Lo Presti D, Carnevale A, Candela V, Stelitano G, Schena E, Nazarian A, Denaro V. Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 17(8):2852. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082852

Chicago/Turabian Style

Longo, Umile G., Alessandra Berton, Laura Risi Ambrogioni, Daniela Lo Presti, Arianna Carnevale, Vincenzo Candela, Giovanna Stelitano, Emiliano Schena, Ara Nazarian, and Vincenzo Denaro. 2020. "Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 17, no. 8: 2852. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082852

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