Does wearing a sling after keyhole tendon repair surgery in the shoulder give a better outcome than not wearing a sling?

ISRCTN ISRCTN27389669
DOI https://doi.org/10.1186/ISRCTN27389669
ClinicalTrials.gov number NCT03913611
Secondary identifying numbers 4.1
Submission date
04/04/2019
Registration date
17/04/2019
Last edited
10/09/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Injury, Occupational Diseases, Poisoning
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
A rotator cuff tear is a damaged tendon around the shoulder. It can cause pain and weakness when moving the shoulder. It is commonly treated using keyhole surgery to reattach the torn tendon to the bone. After surgery, people go through a rehabilitation programme with a physiotherapist that lasts several months. This may involve wearing a sling after surgery. The aim of this study is to see whether a sling is beneficial or detrimental to your recovery after having your torn rotator cuff tendon repaired. Some surgeons prefer to rest the shoulder in a sling for several weeks after surgery to give the repaired tendon some time to heal. This may lead to stiffness due to lack of movement, and weakness of the other muscles around your shoulder, both of which require additional treatment from a physiotherapist. Modern tendon repair techniques are now stronger than ever and a period of rest may no longer be necessary. It is also known that the quality of healing may be improved by early movement.

Who can participate?
Patients undergoing a keyhole repair of a torn tendon in the shoulder

What does the study involve?
Participants' shoulder movements are measured and they complete some questionnaires. They also have a scan 6 months after surgery to check whether the repaired tendon has healed. After surgery, if the surgeon is satisfied that the repair is sound, participants are given an individualised exercise programme by the physiotherapist. This is selected at random from one of two options. One involves wearing a sling for 1-2 days (maximum 1 week), and the other involves using a sling for 4 weeks after surgery. Participants have regular visits to the physiotherapist to monitor their progress over the following 12 months using standard outcome scores, measure their range of movement, and also measure the electrical activity in their shoulder muscles. A scan of their shoulder is also performed after 6 months to determine whether the tendon has healed.

What are the possible benefits and risks of participating?
It is not yet known whether patients benefit more from shorter- or longer-term sling use after rotator cuff repair. Participation will help to determine the answer to this and if participants are allocated to the treatment that is found to be more successful, then they may derive a benefit.

Where is the study run from?
Manchester University NHS Foundation Trust (UK)

When is the study starting and how long is it expected to run for?
January 2017 to August 2020

Who is funding the study?
British Elbow and Shoulder Society (UK)

Who is the main contact?
Chris Peach
chris.peach@mft.nhs.uk

Contact information

Mr Chris Peach
Scientific

Department of Shoulder and Elbow Surgery
Manchester University Foundation Trust
Manchester
M23 9LT
United Kingdom

ORCiD logoORCID ID 0000-0002-2516-4760
Phone +44 (0)161 291 6150
Email chris.peach@mft.nhs.uk

Study information

Study designRandomised clinical trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use contact details to request a participant information sheet.
Scientific titleTraditional versus accelerated rehabilitation programmes following double-row rotator cuff repair: a randomised trial to compare patient outcomes and structural failure rates
Study acronymS-START
Study objectivesThere is a difference in Oxford Shoulder Score 3 months after rotator cuff repair in patients who have an accelerated rehabilitation programme versus traditional rehabilitation.
Ethics approval(s)Approved 01/04/2019, West of Scotland REC 5 (West of Scotland Research Ethics Service, West Glasgow Ambulatory Care Hospital, Dalnair Street, Glasgow, G3 8SW; Tel: +44 (0)141 232-1804; Email: WoSREC5@ggc.scot.nhs.uk), ref: 19/WS/0008
Health condition(s) or problem(s) studiedRotator cuff tears
InterventionThe study will involve patients who are having keyhole surgery to repair their torn rotator cuff tendons. If the surgeon achieves a secure repair, patients will be randomly allocated by sealed envelope to traditional rehabilitation or accelerated rehabilitation.

Traditional rehabilitation will require use of a sling for 4-6 weeks, and those in the accelerated group will be asked to wear it for comfort, for up to 1 week. Over the following 12 months, the researchers shall assess patients’ outcomes using standard outcome scores (e.g. Oxford Shoulder Score), measure their range of movement, and also measure the electrical activity in their shoulder muscles. They shall also perform a scan of their shoulder after 6 months to determine whether the tendon has healed to see whether accelerated rehabilitation affects healing.
Intervention typeDevice
Pharmaceutical study type(s)
PhaseNot Applicable
Drug / device / biological / vaccine name(s)
Primary outcome measurePrimary functional outcome measured using Oxford Shoulder Score (OSS) at 3 months post op (at patient consultation)
Secondary outcome measures1. Pain and function measured using Shoulder Pain and Disability Index (SPADI) at 6 weeks, 3 months, 6 months and 12 months
2. Quality of life measured using EQ5D-5L at 6 weeks, 3 months, 6 months and 12 months
3. Pain measured using VAS at 6 weeks, 3 months, 6 months and 12 months
4. Range of movement measured by clinical assessment with long arm goniometer at 6 weeks, 3 months, 6 months and 12 months at patient consultation
5. Integrity of the repair assessed using MRI scan at 6 months post op
Overall study start date08/01/2017
Completion date01/08/2020

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participants120
Key inclusion criteriaAll patients awaiting arthroscopic rotator cuff tear surgery
Key exclusion criteria1. Non-English speaker
2. Concomitant musculoskeletal disease in ipsilateral arm
3. Unfit for surgical intervention
4. Subscapularis tear
5. Massive cuff tear
6. Intra-operatively, if the tear is found not to be repairable
7. If only a partial repair was possible
8. If the repair was under tension
Date of first enrolment01/10/2019
Date of final enrolment01/10/2021

Locations

Countries of recruitment

  • England
  • United Kingdom

Study participating centre

Manchester University NHS Foundation Trust
Southmoor Road
Manchester
M23 9LT
United Kingdom

Sponsor information

Manchester University NHS Foundation Trust
Hospital/treatment centre

Southmoor Road
Manchester
M23 9LT
England
United Kingdom

Phone +44 (0)161 291 6150
Email chris.peach@mft.nhs.uk
Website mft.nhs.uk
ROR logo "ROR" https://ror.org/00he80998

Funders

Funder type

Other

British Elbow and Shoulder Society; Grant Codes: Ltr014PPG/PO. No. CPRD063001

No information available

NIHR Central Commissioning Facility (CCF)

No information available

Results and Publications

Intention to publish date01/04/2021
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryData sharing statement to be made available at a later date
Publication and dissemination plan1. Results to be presented at national and international scientific meetings
2. Results will be disseminated to trial participants in plain English form
3. Results will be published in peer-reviewed scientific journals
4. The protocol will be available on the study website
IPD sharing planThe data sharing plans for the current study are unknown and will be made available at a later date

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
HRA research summary 28/06/2023 No No

Editorial Notes

10/09/2021: The NCT number has been added.
07/08/2020: Recruitment for this study is no longer paused and the following changes have been made:
1. The recruitment start date has been changed from 01/04/2019 to 01/10/2019.
2. The recruitment end date has been changed from 01/12/2020 to 01/10/2021.
17/04/2020: Due to current public health guidance, recruitment for this study has been paused.
15/04/2019: Trial's existence confirmed by the NIHR.