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Am Fam Physician. 2014;89(10):824

Clinical Question

In adults with nontraumatic supraspinatus tears, is physical therapy (PT) alone as effective as PT plus surgery after one year?

Bottom Line

In this study, the long-term outcomes of adults with nontraumatic supraspinatus tears who are treated conservatively are similar to those of patients treated with two different surgical approaches. (Level of Evidence = 2b)

Synopsis

This group of surgeons randomly assigned 180 adults older than 55 years with isolated nontraumatic supraspinatus tears to one of three treatment groups: PT, PT plus acromioplasty, or PT plus acromioplasty plus rotator cuff repair. Although they used intention-to-treat analysis to evaluate the main outcome, the authors do not report if any study personnel (other than the radiologists) were aware of the treatment allocation. The research staff determined the multidimensional Constant score for each patient at baseline and then at three, six, and 12 months after intervention. The authors report that a difference of 10 points on the Constant score is the minimal clinically important difference. Thirteen patients did not complete the study. At three months, the group receiving triple therapy had lower Constant scores than the other groups, but by six months the scores were comparable. At the end of the study, 87% of patients treated with PT alone were satisfied, compared with 95% and 96% in the other treatment groups. The study was designed to have enough power to detect modest differences in the Constant score. This is one of many studies showing long-term outcomes of various orthopedic interventions are comparable (e.g., steroid injections for shoulder pain vs. conservative treatment).

Study design: Randomized controlled trial (nonblinded)

Funding source: Unknown/not stated

Allocation: Concealed

Setting: Outpatient (specialty)

Reference: KukkonenJJoukainenALehtinenJet alTreatment of non-traumatic rotator cuff tears: a randomised controlled trial with one-year clinical results. Bone Joint J.2014; 96( 1): 75– 81.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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