Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

The Effectiveness of CPM versus Accelerated Therapy Protocol

No description
by

Matt Ferlindes

on 1 May 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of The Effectiveness of CPM versus Accelerated Therapy Protocol

The Effectiveness of CPM versus Accelerated Therapy Protocol in Decreasing Time Required for Return to Sport Following Bankart Lesion Repair
By: Kelsey Egger, Matt Ferlindes, Amanda Gumm, and Gregor Wenig
Research Question
In patients who had an arthroscopic glenolabral Bankart repair, does continuous passive motion (CPM), paired with traditional physical therapy, decrease time required to return to sport more than traditional physical therapy and accelerated therapy protocols?

Background
Shoulder dislocations are common in athletics and often result in Bankart Lesions.
What are bankart lesions?
How are they repaired?

Physical therapy is often required following surgery.

CPM has become popular in early stages of therapy.
What is CPM?

Should CPM be utilized following a Bankart repair?

Rotator Cuff Tear Rehabilitation
Use of Early Motion (5, 6, 7, 8)
ROM (flexion and ER) and pain improvements in the short term vs. the long term
No greater risk of re-tear

CPM Use (4, 9, 10)
ROM and pain improvements at 3 months
ROM improvements extending to 6 months
Du Plessis et al. (10)
CPM in addition to PT had better pain, ROM, and strength outcomes in shorter amount of time
Improvements disappear at 6 months and 1 year
Theory Behind CPM Use
Low intensity force that puts stress on the tissues, which is thought to prevent joint stiffness (10)

Second order neurons in the dorsal horn become less sensitive to painful stimuli (11)
Rotator Cuff and Labrum
Work together to reinforce and provide stability to the glenohumeral (GH) joint (12)

Distal attachment of rotator cuff tendons fuses with the joint capsule (12)

Kinetic chain force transmission of extreme overhead upper extremity motions often seen in athletics (13)

Rotator cuff injuries often correlated to labral tears (14)
Kim et al. (3)
“Accelerated Rehab” group had improved pain
and returned to prior level of function faster than immobilization group
Did not have a greater chance at re-dislocation
Younger population
Glenoid Treatment and
Rehabilitation
Importance
Subjects
Research Findings
Early Motion
Same Long Term Outcomes
Short Term Improvements

Clinical Importance
Younger, athletic population
PT Labor
Health Care System

Inclusion Criteria
Patients with a Bankart lesion caused by a first traumatic dislocation during an athletic performance, competition, or practice repaired by a suture anchor technique
Exclusion Criteria
Previous and additional shoulder complications
Age Range
18-40 years old
Statistics:
Power analysis requires N=60 subject to reach 80% power
All 3 groups will be compared for normal distribution of age, gender, and hand dominance

Kirkley et al. (17)
Surgery vs. Immobilization
Surgery = Better functional performance in a shorter amount of time with fewer re-dislocations
Use of surgery in a younger and more active population

Rehabilitation of Bankart Repair
Method of Group
Assignment
60 envelopes: 20 IMMOBILIZATION, 20 ACCELERATED, 20 CPM

Post surgery the attending nurse will open a random envelope with the random group assignment for the included subject

Informed Consent
Informed consent will be discussed and signed prior to surgery.
Procedures
One PT will carry out the intervention.

A separate PT will assess the subjects’ ROM, pain, strength, and functionality
Every 2 weeks for the first 3 months
On the first of the month for the following 3 months

In the last 3 months: The same PT will record the amount of days to return to sport
One surgeon will assess when patients can return to sport
Both the PT doing the testing and the surgeon will be blinded to group assignment

Two Year Follow-Up: dislocation recurrence rate via self-reported log
Outcome Measures
Statistical Analysis
Primary Outcomes
Return to Sport
Recurrent Dislocations

Secondary Outcomes
Functionality
Pain
Range of Motion
Strength



Alpha = 0.05

Two way ANOVA with repeated measures = pain, range of motion, and strength

One way ANOVA = number of days to return to sport and recurrent dislocations

Post hoc used to determine where difference occurs


Limitations
Maturation

History

Potential for attrition

Generalizability- Bankart lesion, athletes, age range
Intervention
http://file.scirp.org/Html/13-1320049_19621.htm
References
1. Warme WJ, Matsen III FA. Bankart repair for unstable dislocating shoulders. UW Medicine Orthopedics and Sports Medicine Web site. http://www.orthop.washington.edu/?q=patient-care/articles/shoulder/bankart-repair-for-unstable-dislocating-shoulders.html. Accessed April 19, 2015.

2. Thompson S, Al-Saati M, Litchfield R. Anterior Shoulder Instability. In DeLee & Drez's Orthopaedic Sports Medicine (4th ed., Vol. 46, pp. 495-516). Philadelphia, PA: Saunders Elsevier. 2015. Retrieved from https://www-clinicalkey-com.pioproxy.carrollu.edu/#!/content/book/3-s2.0-B9781455743766001463

3. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic bankart repair for selected cases: a prospective randomized clinical study. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2003;19:722-731.

4. Garofalo R, Conti M, Notarnicola A, Maradei L, Giardella A, Castagna A. Effects of one-month continuous passive motion after arthroscopic rotator cuff repair: results at 1-year follow-up of a prospective randomized study. Musculoskeletal surgery, 2010; 94 (1): S79-S83. doi: 10.1007/s12306-010-0058-7

5. Kim YS, Chung SW, Kim JY, Ok JH, Park I, Oh JH. Is early passive motion exercise necessary after arthroscopic rotator cuff repair?. The American Journal of Sports Medicine. 2012; 40(4): 815-821. doi: 10.1177/0363546511434287.

6. Keener JD, Galatz LM, Stobbs-Cucchi G, Patton R, Yamaguchi K. Rehabilitation following arthroscopic rotator cuff repair: A prospective randomized trial of immobilization compared with early motion. J Bone Joint Surg Am. 2014; 96A(1): 11-19.

7. Ribboh JC, Garrigues GE. Early passive motion versus immobilization after arthroscopic rotator cuff repair. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2014; 30(8): 997-1005.

8. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2012; 28(1): 34-42.

9. Raab MG, Rzeszutko D, O’Connor W, Greatting MD. Early results of continuous passive motion after rotator cuff repair: A prospective, randomized, blinded, controlled study. The American Journal of Othopedics. 1996; 25(3): 214-220.

10. Du Plessis M, Eksteen E, Jenneker A, Kriel E, Mentoor C, Study T, van Staden D, Morris LD. The effectiveness of continuous passive motion on range of motion, pain and muscle strength following rotator cuff repair: a systematic review. Clinical Rehabilitation. 2011; 25: 291-302. doi: 10.1177/0269215510380835.

11. Dundar U, Toktas H, Cakir T, Evcik D, Kavuncu V. Continuous passive motion provides good pain control in patients with adhesive capsulitis. International Journal of Rehabilitation Research. 2009. 32(3); 193-198.

12. Neumann DA. Kinesiology of the musculoskeletal system: Foundation for rehabilitation. St. Louis, MO: Mosby, Inc; 2010.

13. ElAttrache N, Gonzalez-Lomas G, Ahmad C. The Shoulder in Athletes. In The Shoulder (4th ed., pp. 1437-1488). Philadelphia, PA: Saunders Elsevier. 2009. Retrieved from https://www-clinicalkey-com.pioproxy.carrollu.edu/#!/content/book/3-s2.0-B9781416034278500362.

14. Hwang E, Carpenter JE, Hughes RE, Palmer ML. Shoulder labral pathomechanics with rotator cuff tears. Journal of Biomechanics. 2014; 47: 1733-1738.

15. Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ. Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. The American journal of sports medicine. 2010; 38(1): 99-104. doi: 10.1177/0363546509346393.

16. Stalzer S, Wahoff M, Scanlan M. Rehabilitation following hip arthroscopy. Clinics in sports medicine. 2006; 25: 337-357.

17. Kirkley A, Werstine R, Ratjek A, Griffin S. Prospective randomized clinical trial comparing the effectiveness of immediate arthroscopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder: long-term evaluation. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2005; 21(1): 55-63.

18. Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC musculoskeletal disorders. 2003; 4(1): 11

19. Bang, MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2000; 30(3): 126-137.

20. Liavaag S, Stiris MF, Lindland ES, Enger M, Svenningsen S, Brox JI. Do bankart lesions heal better in shoulders immobilized in external rotation?: A randomized single-blind study of 55 patients examined with MRI. Acta Orthopaedica. 2009; 80(5): 579-584. doi: 10.3109/17453670903278266.
http://www.cleveland.com/cavs/index.ssf/2015/04/kevin_love_shoulder_injury_cle.html
http://www.electro-medical.com/artomot-s3-shoulder-continuous-passive-motion-machine-cpm-030842/cpm-machine/

http://www.theguardian.com/sport/2009/may/07/tom-shanklin-british-irish-lions
https://www.ncmedical.com/item_1897.html
Full transcript