Rehabilitation Following Reverse Total Shoulder Arthroplasty

NCT03804853 | Recruiting DMC

• 1 other identifier: 18-259
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 1

Brief Summary

Reverse total shoulder arthroplasty (RTSA) has been successful in patients with rotator cuff arthropathy, proximal humerus fractures, failed primary total shoulder arthroplasty or failed hemiarthroplasty, and massive irreparable rotator cuff tear. Patients who undergo an RTSA report pain relief and functional range of motion. It has been more than 20 years since the advent of the RTSA construct but an immediate post-operative rehabilitation with active shoulder range of motion has not been prospectively studied in comparison to the traditional post-operative rehabilitation highlighted by Boudreau et al.12 Investigators plan to prospectively follow our patients following RTSA undergoing an immediate active shoulder rehabilitation (IASR) vs traditional rehabilitation in a randomized controlled fashion. Investigators plan to document clinical outcomes, complications and cost effectiveness out to 1 year. The study will hopefully fulfill the Triple Aim model for HealthPartners by improving the health of the population, improve the experience of each individual, and make healthcare affordable by decreasing the total cost of care.

Conditions

Shoulder Osteoarthritis

Keywords

Rehabilitiation; Reverse total shoulder

Outcome Measures

Primary Outcomes (19)

• American Society for Elbow and Shoulder Score

  1\. American Shoulder and Elbow score (ASES) is a scale that measures shoulder pain and function with 11 items, one item for pain and 10 items for function. The score for each subscale is out of 50 (0-50), with a higher score indicating a better outcome. The total score is a sum of both subscales, ranging between 0-100, using the following formula, Total score = ((10 - VAS pain) × 5) + (5/3 × sum of function items).

  Pre-operatively

• American Society for Elbow and Shoulder Score

  1\. American Shoulder and Elbow score (ASES) is a scale that measures shoulder pain and function with 11 items, one item for pain and 10 items for function. The score for each subscale is out of 50 (0-50), with a higher score indicating a better outcome. The total score is a sum of both subscales, ranging between 0-100, using the following formula, Total score = ((10 - VAS pain) × 5) + (5/3 × sum of function items).

  2 weeks

• American Society for Elbow and Shoulder Score

  1\. American Shoulder and Elbow score (ASES) is a scale that measures shoulder pain and function with 11 items, one item for pain and 10 items for function. The score for each subscale is out of 50 (0-50), with a higher score indicating a better outcome. The total score is a sum of both subscales, ranging between 0-100, using the following formula, Total score = ((10 - VAS pain) × 5) + (5/3 × sum of function items).

  3 months

• American Society for Elbow and Shoulder Score

  1\. American Shoulder and Elbow score (ASES) is a scale that measures shoulder pain and function with 11 items, one item for pain and 10 items for function. The score for each subscale is out of 50 (0-50), with a higher score indicating a better outcome. The total score is a sum of both subscales, ranging between 0-100, using the following formula, Total score = ((10 - VAS pain) × 5) + (5/3 × sum of function items).

  6 months

• American Society for Elbow and Shoulder Score

  1\. American Shoulder and Elbow score (ASES) is a scale that measures shoulder pain and function with 11 items, one item for pain and 10 items for function. The score for each subscale is out of 50 (0-50), with a higher score indicating a better outcome. The total score is a sum of both subscales, ranging between 0-100, using the following formula, Total score = ((10 - VAS pain) × 5) + (5/3 × sum of function items).

  1 year

• Simple Shoulder Test

  2\. The Simple Shoulder Test Score (SST) is a 12 item, yes/no questionnaire assessing shoulder function. There are 2 items on function related to pain, 7 items about functions/strength and 3 items about range of motion. There are no subscales. A "yes" response is 1 point and a "no" response is 0 point. The following formula is used to calculate a score out of 100 (0-100), total= number of "yes" items/number of completed items × 100 = % "yes" responses. A higher score indicates better function from a scale of 0-100.

  Pre-operatively

• Simple Shoulder Test

  2\. The Simple Shoulder Test Score (SST) is a 12 item, yes/no questionnaire assessing shoulder function. There are 2 items on function related to pain, 7 items about functions/strength and 3 items about range of motion. There are no subscales. A "yes" response is 1 point and a "no" response is 0 point. The following formula is used to calculate a score out of 100 (0-100), total= number of "yes" items/number of completed items × 100 = % "yes" responses. A higher score indicates better function from a scale of 0-100.

  2 weeks

• Simple Shoulder Test

  2\. The Simple Shoulder Test Score (SST) is a 12 item, yes/no questionnaire assessing shoulder function. There are 2 items on function related to pain, 7 items about functions/strength and 3 items about range of motion. There are no subscales. A "yes" response is 1 point and a "no" response is 0 point. The following formula is used to calculate a score out of 100 (0-100), total= number of "yes" items/number of completed items × 100 = % "yes" responses. A higher score indicates better function from a scale of 0-100.

  3 months

• Simple Shoulder Test

  2\. The Simple Shoulder Test Score (SST) is a 12 item, yes/no questionnaire assessing shoulder function. There are 2 items on function related to pain, 7 items about functions/strength and 3 items about range of motion. There are no subscales. A "yes" response is 1 point and a "no" response is 0 point. The following formula is used to calculate a score out of 100 (0-100), total= number of "yes" items/number of completed items × 100 = % "yes" responses. A higher score indicates better function from a scale of 0-100.

  6 months

• Simple Shoulder Test

  2\. The Simple Shoulder Test Score (SST) is a 12 item, yes/no questionnaire assessing shoulder function. There are 2 items on function related to pain, 7 items about functions/strength and 3 items about range of motion. There are no subscales. A "yes" response is 1 point and a "no" response is 0 point. The following formula is used to calculate a score out of 100 (0-100), total= number of "yes" items/number of completed items × 100 = % "yes" responses. A higher score indicates better function from a scale of 0-100.

  1 year

• PROMIS Global 10

  3\. The PROMIS Global-10 is a global health quality of life patient reported outcome tool. It is part of the Patient-Reported Outcomes Measurement Information System (PROMIS). It measures symptoms, functioning, and healthcare quality of life for a wide variety of conditions. The PROMIS Global-10 consists of 10 questions assessing physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. 7 questions inquire about health in "general" and 3 questions assess emotional problems, fatigue and pain in the last 7 days. Raw subscale scores for physical and mental health each are calculated out of 20. The raw score are converted to T scores for physical and mental health using the following formulas: the Global Physical Health score is generated by summing responses to Global03, Global06, Global07rescored, and Global08rescored. The Global Mental Health score is generated by summing responses to Global02, Global04, Global05, and Global10rescored.

  Pre-operatively

• PROMIS Global 10

  3\. The PROMIS Global-10 is a global health quality of life patient reported outcome tool. It is part of the Patient-Reported Outcomes Measurement Information System (PROMIS). It measures symptoms, functioning, and healthcare quality of life for a wide variety of conditions. The PROMIS Global-10 consists of 10 questions assessing physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. 7 questions inquire about health in "general" and 3 questions assess emotional problems, fatigue and pain in the last 7 days. Raw subscale scores for physical and mental health each are calculated out of 20. The raw score are converted to T scores for physical and mental health using the following formulas: the Global Physical Health score is generated by summing responses to Global03, Global06, Global07rescored, and Global08rescored. The Global Mental Health score is generated by summing responses to Global02, Global04, Global05, and Global10rescored.

  2 weeks

• PROMIS Global 10

  3\. The PROMIS Global-10 is a global health quality of life patient reported outcome tool. It is part of the Patient-Reported Outcomes Measurement Information System (PROMIS). It measures symptoms, functioning, and healthcare quality of life for a wide variety of conditions. The PROMIS Global-10 consists of 10 questions assessing physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. 7 questions inquire about health in "general" and 3 questions assess emotional problems, fatigue and pain in the last 7 days. Raw subscale scores for physical and mental health each are calculated out of 20. The raw score are converted to T scores for physical and mental health using the following formulas: the Global Physical Health score is generated by summing responses to Global03, Global06, Global07rescored, and Global08rescored. The Global Mental Health score is generated by summing responses to Global02, Global04, Global05, and Global10rescored.

  3 months

• PROMIS Global 10

  3\. The PROMIS Global-10 is a global health quality of life patient reported outcome tool. It is part of the Patient-Reported Outcomes Measurement Information System (PROMIS). It measures symptoms, functioning, and healthcare quality of life for a wide variety of conditions. The PROMIS Global-10 consists of 10 questions assessing physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. 7 questions inquire about health in "general" and 3 questions assess emotional problems, fatigue and pain in the last 7 days. Raw subscale scores for physical and mental health each are calculated out of 20. The raw score are converted to T scores for physical and mental health using the following formulas: the Global Physical Health score is generated by summing responses to Global03, Global06, Global07rescored, and Global08rescored. The Global Mental Health score is generated by summing responses to Global02, Global04, Global05, and Global10rescored.

  6 months

• PROMIS Global 10

  3\. The PROMIS Global-10 is a global health quality of life patient reported outcome tool. It is part of the Patient-Reported Outcomes Measurement Information System (PROMIS). It measures symptoms, functioning, and healthcare quality of life for a wide variety of conditions. The PROMIS Global-10 consists of 10 questions assessing physical health, mental health, social health, pain, fatigue, and overall perceived quality of life. 7 questions inquire about health in "general" and 3 questions assess emotional problems, fatigue and pain in the last 7 days. Raw subscale scores for physical and mental health each are calculated out of 20. The raw score are converted to T scores for physical and mental health using the following formulas: the Global Physical Health score is generated by summing responses to Global03, Global06, Global07rescored, and Global08rescored. The Global Mental Health score is generated by summing responses to Global02, Global04, Global05, and Global10rescored.

  1 year

• Range of Motion

  4\. Range of motion (ROM) of the shoulder is an objective measure of shoulder function. A blinded examiner will measure the range of motion in forward elevation, external rotation in the neutral position external rotation with the arm in abduction, internal rotation in the neutral position, and internal rotation with the arm in abduction. A goniometer will be used measuring to the nearest degree. The range of motion for forward elevation will range between 0-180 degrees with a higher number indicating a better outcome. External and internal rotation ranges from 0-90 degrees with a higher number indicating a better outcome.

  Pre-operatively, 3 months, 6 months, 1 year post-operatively

• Range of Motion

  4\. Range of motion (ROM) of the shoulder is an objective measure of shoulder function. A blinded examiner will measure the range of motion in forward elevation, external rotation in the neutral position external rotation with the arm in abduction, internal rotation in the neutral position, and internal rotation with the arm in abduction. A goniometer will be used measuring to the nearest degree. The range of motion for forward elevation will range between 0-180 degrees with a higher number indicating a better outcome. External and internal rotation ranges from 0-90 degrees with a higher number indicating a better outcome.

  3 months

• Range of Motion

  4\. Range of motion (ROM) of the shoulder is an objective measure of shoulder function. A blinded examiner will measure the range of motion in forward elevation, external rotation in the neutral position external rotation with the arm in abduction, internal rotation in the neutral position, and internal rotation with the arm in abduction. A goniometer will be used measuring to the nearest degree. The range of motion for forward elevation will range between 0-180 degrees with a higher number indicating a better outcome. External and internal rotation ranges from 0-90 degrees with a higher number indicating a better outcome.

  6 months

• Range of Motion

  4\. Range of motion (ROM) of the shoulder is an objective measure of shoulder function. A blinded examiner will measure the range of motion in forward elevation, external rotation in the neutral position external rotation with the arm in abduction, internal rotation in the neutral position, and internal rotation with the arm in abduction. A goniometer will be used measuring to the nearest degree. The range of motion for forward elevation will range between 0-180 degrees with a higher number indicating a better outcome. External and internal rotation ranges from 0-90 degrees with a higher number indicating a better outcome.

  1 year

Secondary Outcomes (1)

• Subscapularis Tear

  1 year

Other Outcomes (1)

• Number of PT Visits

  1 Year

Study Arms (2)

Immediate Active Shoulder Rehabilitation

EXPERIMENTAL

Other: Rehabilitiation

Traditional Should Rehabilitation

ACTIVE COMPARATOR

Other: Rehabilitiation

Interventions

Rehabilitiation OTHER

This study will be a non-blinded randomized controlled outcomes study evaluating outcomes at baseline, 2 weeks, 6 weeks, 3 months, 6 months, and 1 year post-operatively from a primary reverse total shoulder arthroplasty with two different post-operative physical rehabilitation protocols. There will be 2 groups, one undergoing the immediate active shoulder physical therapy protocol consisting of four quadrant stretches and full active motion of the shoulder from post op day 1 in the hospital. The second group will follow the traditional TRIA physical therapy protocol consisting of PT (standard of care) followed by a gradual return to active range of motion of the shoulder beginning by week 6, calling for 18 physical therapy visits. The physical therapy will occur where the patient is most comfortable receiving it.

Immediate Active Shoulder Rehabilitation; Traditional Should Rehabilitation

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \> 55 years of age.
• Candidate for a primary reverse total shoulder arthroplasty.
• Capable of completing self-administered questionnaires.
• Be willing and able to return for all study-related follow-up procedures.
• Able and willing to give informed consent.
• Proficient in the English language.

You may not qualify if:

• In-Clinic:
• Patients planning on undergoing a Primary Reverse Shoulder Total Arthroplasty due to proximal humeral fracture.
• Previous shoulder surgery including previous total shoulder arthroplasty or reverse total shoulder arthroplasty or hemiarthroplasty, or instability repairs
• Active bacterial infection of the shoulder.
• Any concomitant shoulder procedure.
• Additional ipsilateral or contralateral upper limb pathology that requires active treatment (i.e. surgery or brace).
• Inflammatory arthropathy.
• Diagnosed with Rheumatoid arthritis
• Diagnosed with gout.
• Subject is on chronic anticoagulation due to a bleeding disorder or has taken anticoagulants within 10 days prior to surgery.
• Peripheral vascular disease or other vascular disorders that would impair healing.
• Peripheral neuropathy or other neurological disorders that may impair the patient to ambulate.
• Patient is on workers compensation.
• Any condition requiring chemotherapy.
• Active tobacco user or former tobacco user who is not free of using tobacco for 8 weeks.

Sponsors & Collaborators

• HealthPartners Institute: lead
• TRIA Orthopaedic Center: collaborator

Study Sites (1)

TRIA Orthopaedic Center

Bloomington, Minnesota, 55431, United States

RECRUITING

Central Study Contacts

Megan Reams

CONTACT

952-806-5329; megan.reams@tria.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 8, 2019
• First Posted: January 15, 2019
• Study Start: December 12, 2018
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: June 5, 2025

Record last verified: 2025-06

Locations

US (1)