Surgical repair VS acromioplasty and physiotherapy in non-traumatic rotator cuff tear .
Este estudo foi identificado como tendo um impacto potencialmente elevado.
A métrica de Alto Impacto da OE, baseada em IA, estima a influência que um artigo poderá ter, integrando sinais da revista em que foi publicado e do conteúdo científico do próprio artigo.
Desenvolvido com recurso ao mais avançado processamento de linguagem natural, o modelo High Impact da OE prevê com maior precisão o desempenho futuro de um estudo em termos de citações do que o fator de impacto da revista por si só.
Isto permite o reconhecimento precoce de investigação clinicamente significativa e ajuda os leitores a concentrarem-se nos artigos com maior probabilidade de moldar a prática futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(9):15 Bone Joint J. 2014 Jan;96-B(1):75-81. doi: 10.1302/0301-620X.96B1.32168.Patients (180 shoulders) above 55 years of age with non-traumatic supraspinatus tears were analyzed one year post-intervention to determine if rotator cuff repair is superior to alternative treatment approaches. Patients were randomly allocated to a physiotherapy group, acromioplasty and physiotherapy group, or rotator cuff repair, acromioplasty and physiotherapy group and evaluated for outcome using the Constant score. Results revealed that rotator cuff repair did not yield superior results compared to acromioplasty and/or physiotherapy. Surgical interventions were associated with significantly greater costs than physiotherapy alone.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Rotator cuff tears can be categorized as traumatic or non-traumatic in origin, with non-traumatic tears being prevalent in the majority of individuals over 55 years of age. While surgical repair is often encouraged for non-traumatic rotator cuff tears in this age group, there remains a lack of comparative evidence to alternative treatment methods, such as acromioplasty and conservative treatment. To determine the efficacy of non-traumatic rotator cuff tears, different treatments options for patients above 55 years of age were compared one year post-intervention.
Qual era a principal questão de investigação?
Does rotator cuff repair yield superior results in terms of Constant score when compared to acromioplasty and/or physiotherapy treatments one year post-intervention?
- Mean Constant scores were 74.1 (SD 14.2) in group 1, 77.2 (SD 13.0) in group 2, and 77.9 (SD 12.1) in group 3 (p=0.34) at 1 year.
- There was a significant difference between groups terms of pain (p=0.0321) and activities of daily living (p<0.0001), with higher scores registered in the repair group and acromioplasty group compared to physiotherapy alone. Constant sub-scores in range of movement (p=0.74) and strength (p=0.76) did not differ significantly between groups.
- Percent of patients satisfied with their assigned intervention at 1 year follow up was 87% in group 1, 96% in group 2 and 95% in group 3 (p=0.14).
- Cost associated with treatment was an average 2417 euro (SD 1443) for physiotherapy, 4765 euro (SD 896) for acromioplasty and physiotherapy, and 5709 euro for repair, acromioplasty, and physiotherapy (p<0.0001). Costs were mainly attributable to indirect societal cost (including operation, supplies, patient care), which averaged 2130, 4486 and 5461 euro in each group, respectively (p<0.0001).
- Four patients (4 shoulders; 7.3%) who received physiotherapy and 1 patient (1 shoulder; 1.8%) who received acromioplasty and physiotherapy underwent rotator cuff repair after a mean 0.7 years (0.65-0.76).
- Intraoperatively, additional AC resection was performed in 7 shoulders (12%) allocated to acromioplasty and 8 shoulders (15%) allocated the repair and acromioplasty. Biceps tenotomy was performed in 29 shoulders (51%) and 23 shoulders (42%) of these groups, respectively.
De que é que me devo lembrar mais?
In the treatment of non-traumatic supraspinatus tears in patients above the age of 55, there was no significant difference in functional outcome or patient satisfaction after 1 year between physiotherapy, acromioplasty and physiotherapy, or repair, acromioplasty and physiotherapy. Costs associated with surgical interventions were significantly higher than physiotherapy alone.
Como é que isto afectará o tratamento dos meus doentes?
Based on these findings, this study suggests that a conservative treatment method with physiotherapy may be as effective as surgery, either through acromioplastry and/or repair, for non-traumatic rotator cuff tears in older patients, and that lower costs with physiotherapy may be more apt in primary treatment. It is recommended studies with longer follow up times confirm the validity of these findings.
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