Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial

The ARTISAN collaborators

doi:10.1136/bmj-2023-076925

Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial

The ARTISAN collaborators

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

8 Citations (Scopus)

Abstract

OBJECTIVE: To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.

DESIGN: Pragmatic, multicentre, randomised controlled trial (ARTISAN).

SETTING AND PARTICIPANTS: Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.

INTERVENTIONS: One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.

MAIN OUTCOME MEASURES: The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.

RESULTS: 482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).

CONCLUSIONS: An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN63184243.

Original language	English
Pages (from-to)	e076925
Journal	BMJ (Clinical research ed.)
Volume	384
DOIs	https://doi.org/10.1136/bmj-2023-076925
Publication status	Published - 17 Jan 2024

Bibliographical note

Keywords

Adult
Female
Humans
Male
Middle Aged
Cost-Benefit Analysis
Joint Instability
Physical Therapy Modalities
Quality of Life
Shoulder Dislocation/etiology
Shoulder Joint

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@article{0b3bec1c2f0345f8a097fa9f06d4f2e8,

title = "Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial",

abstract = "OBJECTIVE: To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DESIGN: Pragmatic, multicentre, randomised controlled trial (ARTISAN).SETTING AND PARTICIPANTS: Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.INTERVENTIONS: One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.MAIN OUTCOME MEASURES: The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.RESULTS: 482 participants were recruited from 40 sites in the UK. 354 (73\%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66\%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95\% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).CONCLUSIONS: An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.TRIAL REGISTRATION: Current Controlled Trials ISRCTN63184243.",

keywords = "Adult, Female, Humans, Male, Middle Aged, Cost-Benefit Analysis, Joint Instability, Physical Therapy Modalities, Quality of Life, Shoulder Dislocation/etiology, Shoulder Joint",

author = "\{The ARTISAN collaborators\} and Kearney, \{Rebecca S\} and Ellard, \{David R\} and Helen Parsons and Aminul Haque and James Mason and Henry Nwankwo and Helen Bradley and Stephen Drew and Chetan Modi and Howard Bush and David Torgerson and Martin Underwood",

note = "{\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2024",

month = jan,

day = "17",

doi = "10.1136/bmj-2023-076925",

language = "English",

volume = "384",

pages = "e076925",

journal = "BMJ (Clinical research ed.)",

issn = "0959-8138",

publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN)

T2 - pragmatic, multicentre, randomised controlled trial

AU - The ARTISAN collaborators

AU - Kearney, Rebecca S

AU - Ellard, David R

AU - Parsons, Helen

AU - Haque, Aminul

AU - Mason, James

AU - Nwankwo, Henry

AU - Bradley, Helen

AU - Drew, Stephen

AU - Modi, Chetan

AU - Bush, Howard

AU - Torgerson, David

AU - Underwood, Martin

PY - 2024/1/17

Y1 - 2024/1/17

N2 - OBJECTIVE: To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DESIGN: Pragmatic, multicentre, randomised controlled trial (ARTISAN).SETTING AND PARTICIPANTS: Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.INTERVENTIONS: One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.MAIN OUTCOME MEASURES: The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.RESULTS: 482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).CONCLUSIONS: An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.TRIAL REGISTRATION: Current Controlled Trials ISRCTN63184243.

AB - OBJECTIVE: To assess the effects of an additional programme of physiotherapy in adults with a first-time traumatic shoulder dislocation compared with single session of advice, supporting materials, and option to self-refer to physiotherapy.DESIGN: Pragmatic, multicentre, randomised controlled trial (ARTISAN).SETTING AND PARTICIPANTS: Trauma research teams at 41 UK NHS Trust sites screened adults with a first time traumatic anterior shoulder dislocation confirmed radiologically, being managed non-operatively. People were excluded if they presented with both shoulders dislocated, had a neurovascular complication, or were considered for surgical management.INTERVENTIONS: One session of advice, supporting materials, and option to self-refer to physiotherapy (n=240) was assessed against the same advice and supporting materials and an additional programme of physiotherapy (n=242). Analyses were on an intention-to-treat basis with secondary per protocol analyses.MAIN OUTCOME MEASURES: The primary outcome was the Oxford shoulder instability score (a single composite measure of shoulder function), measured six months after treatment allocation. Secondary outcomes included the QuickDASH, EQ-5D-5L, and complications.RESULTS: 482 participants were recruited from 40 sites in the UK. 354 (73%) participants completed the primary outcome score (n=180 allocated to advice only, n=174 allocated to advice and physiotherapy). Participants were mostly male (66%), with a mean age of 45 years. No significant difference was noted between advice compared with advice and a programme of physiotherapy at six months for the primary intention-to-treat adjusted analysis (between group difference favouring physiotherapy 1.5 (95% confidence interval -0.3 to 3.5)) or at earlier three month and six week timepoints. Complication profiles were similar across the two groups (P>0.05).CONCLUSIONS: An additional programme of current physiotherapy is not superior to advice, supporting materials, and the option to self-refer to physiotherapy.TRIAL REGISTRATION: Current Controlled Trials ISRCTN63184243.

KW - Adult

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Cost-Benefit Analysis

KW - Joint Instability

KW - Physical Therapy Modalities

KW - Quality of Life

KW - Shoulder Dislocation/etiology

KW - Shoulder Joint

U2 - 10.1136/bmj-2023-076925

DO - 10.1136/bmj-2023-076925

M3 - Article (Academic Journal)

C2 - 38233068

SN - 0959-8138

VL - 384

SP - e076925

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

ER -

Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomised controlled trial

Abstract

Bibliographical note

Keywords

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