A Clinical Comparison of Home-Based and Hospital-Based Exercise Programs Following Arthroscopic Capsulolabral Repair for Anterior Shoulder Instability

in Journal of Sport Rehabilitation
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Context: Ideal rehabilitation method following arthroscopic capsulolabral repair surgery for anterior shoulder instability has not been proven yet. Although rapid or slow protocols were compared previously, home- or hospital-based protocols were not questioned before. Objective: The aim of this prospective unrandomized controlled clinical trial is to compare the clinical outcomes of home-based and hospital-based rehabilitation programs following arthroscopic Bankart repair. Design: Nonrandomized controlled trial. Setting: Orthopedics and physical therapy units of a single institution. Patients: Fifty-four patients (49 males and 5 females) with an average age of 30.5 (9.1) years, who underwent arthroscopic capsulolabral repair and met the inclusion criteria, with at least 1-year follow-up were allocated into 2 groups: home-based (n = 33) and hospital-based (n = 21) groups. Interventions: Both groups received identical rehabilitation programs. Patients in the home-based group were called for follow-up every 3 weeks. Patients in the hospital-based group admitted for therapy every other day for a total of 6 to 8 weeks. Both groups were followed identically after the eighth week and the rehabilitation program continued for 6 months. Main Outcome Measures: Clinical outcomes were assessed using Disabilities of Arm Shoulder Hand, Constant, and Rowe scores. Mann–Whitney U test was used to compare the results in both groups. Wilcoxon test was used for determining the progress in each group. Results: Groups were age and gender matched (P = .61, P = .69). Average number of treatment sessions was 13.8 (7.3) for patients in the hospital-based group. Preoperative Disabilities of Arm Shoulder Hand (27.46 [11.81] vs 32.53 [16.42], P = .22), Constant (58.23 [14.23] vs 54.17 [10.46], P = .13), and Rowe (51.72 [15.36] vs 43.81 [19.16], P = .12) scores were similar between groups. Postoperative scores at sixth month were significantly improved in each group (P = .001, P = .001, and P = .001). No significant difference was observed between 2 groups regarding clinical scores in any time point. Conclusions: We have, therefore, concluded that a controlled home-based exercise program is as effective as hospital-based rehabilitation following arthroscopic capsulolabral repair for anterior shoulder instability.

Eren and Demirhan are with the Department of Orthopaedics and Traumatology, School of Medicine, Koc University, Istanbul, Turkey. Eren is also with the Koc Universitesi Hastanesi, Istanbul, Turkey. Canbulat is with the Department of Physical Therapy and Rehabilitation, School of Medicine, Koc University, Istanbul, Turkey. Atalar is with the Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul, Turkey. Eren, Uçak, and Çerezci are with the Department of Physical Therapy and Rehabilitation, VKV American Hospital, Istanbul, Turkey.

Eren (Ilker.eren@gmail.com) is corresponding author.
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