Skip Navigation
Department of Health and Human Services www.hhs.gov
Agency for Healthcare Research Quality www.ahrq.gov
AHRQ Home | Questions? | Contact Us | Site Map | What's New | Browse | Información en español | E-mail UpdatesE-mail Updates
 
Slide Tray
0 slides

Return to Slide Library

Slides

Add Presentation to Slide Tray Presentation:

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

Slides: 1–12 of 38
This slide set is based on the research presented in a comparative effectiveness review (CER), Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears, that was developed by the University of Alberta Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0023). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information presented here is intended to help health care decisionmakers—clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This information is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, that is, in the context of available resources and circumstances presented by individual patients. Twelve electronic databases (1990 to September 2009), grey literature, trial registries, and reference lists were searched. The methods used to develop this CER followed version 1.0 of the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews published by AHRQ (draft available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf).
Add to tray Remove from tray

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears

Keywords: nonoperative | operative | rotator cuff tear | Comparative effectiveness
Overview (1) Background: Numerous approaches exist for managing rotator cuff (RC) tears. Purpose: To compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears.
Add to tray Remove from tray

Overview (1)

Keywords: benefits | harms | nonoperative | operative | rotator cuff tear | comparative effectiveness
Overview (2) Data sources: Twelve electronic databases (1990 to September 2009), grey literature, trial registries, and reference lists were searched. Study selection: Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. Operative studies in English-language publications and nonoperative and postoperative rehabilitation studies in English, French, or German were considered. Studies were assessed in duplicate. Data extraction: Two reviewers assessed risk for bias by using the Cochrane tool and the Newcastle–Ottawa scale. One reviewer rated the evidence by using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Data were extracted by one reviewer and verified by another.
Add to tray Remove from tray

Overview (2)

Keywords: comparative effectiveness | nonoperative | operative | rotator cuff tear | data sources | study selection | data extraction
Add to tray Remove from tray

Overview (3)

Keywords: nonoperative | operative | rotator cuff tear | data synthesis | outcomes
Overview: Conclusions Overall, the evidence is too limited to provide support for earlier surgical intervention when compared to the current practice of nonoperative interventions followed by surgery if needed. Significant improvements were seen in both operative and nonoperative interventions. However, there is limited evidence for benefits and harms to guide choice among various operative approaches, and insufficient evidence to choose between nonoperative approaches. Future studies are required.
Add to tray Remove from tray

Overview: Conclusions

Keywords: benefits | harms | nonoperative | operative | rotator cuff tear | conclusions
Outline of the Study This slide set is based on a comparative effectiveness review (CER) titled, Comparative Effectiveness of Nonoperative and Operative Treatment for Rotator Cuff Tears, that was developed by the University of Alberta Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) and is available online at effectivehealthcare.ahrq.gov (Contract No. 290-02-0023). CERs represent systematic reviews of the literature and usually compare two or more types of treatments, such as different drugs, devices, or procedures for the same disease. The methods used to develop this CER followed version 1.0 of the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews published by AHRQ (draft available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf). The talk will cover the current evidence from 12 electronic databases (1990 to September 2009), grey literature, trial registries, and reference lists that were searched. Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. The comparative effectiveness review process will be discussed briefly, including the specific questions addressed in this CER and the results from this research. Finally, the benefits and harms of nonoperative and operative interventions and postoperative rehabilitation for rotator cuff tears are presented.
Add to tray Remove from tray

Outline of the Study

Keywords: nonoperative | operative | outcomes | prognostic factors | rotator cuff tear | outline
Incidence of Rotator Cuff Tears Rotator cuff (RC) tears can occur because of traumatic injury or degeneration. Incidence of RC tears is related to increasing age. Fifty-four percent of patients >60 years of age have a partial or complete RC tear when compared with 4 percent of adults <40 years of age. RC tears may be asymptomatic or cause significant pain, weakness, and limitation of motion.
Add to tray Remove from tray

Incidence of Rotator Cuff Tears

Keywords: rotator cuff tear | incidence | symptoms
Managing Rotator Cuff Tears Both nonoperative and operative treatments are used in an attempt to relieve pain and restore shoulder movement and function. Most patients usually first undergo 6 to 12 weeks of nonoperative treatment, which may consist of any combination of pain management (medications and injections), rest from activity, passive and active exercise, and treatments with heat, cold, or ultrasound.
Add to tray Remove from tray

Managing Rotator Cuff Tears

Keywords: managing rotator cuff tears | nonoperative | operative | relieve pain | shoulder function | treatment
Managing Rotator Cuff Tears (2) The rotator cuff may be surgically repaired by using an open, mini-open, or all-arthroscopic approach when nonoperative therapy fails or for certain patients with traumatic tears. Following operative interventions, various postoperative rehabilitation programs are used to restore range of motion, muscle strength, and function. Patients and clinicians face several decisional dilemmas, including whether to opt for early surgical intervention or if and when to forgo nonoperative treatment for operative intervention.
Add to tray Remove from tray

Managing Rotator Cuff Tears (2)

Keywords: arthroscopic repair | mini-open repair | nonoperative | open repair | postoperative rehabilitation | rotator cuff tear
The CER Development Process The comparative effectiveness review (CER) topic, Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears, was nominated in a public process. The nominated topic was reviewed and selected based on need, importance, and feasibility. Sufficient research into the current literature by experts in the field and stakeholders determined that a CER on the operative and nonoperative treatments and postoperative rehabilitation of rotator cuff tears was needed and would not duplicate existing work. Based on this research, key clinical questions that the report would address were developed and made available for public comment. The Agency for Healthcare Research and Quality (AHRQ) then commissioned the University of Alberta Evidence-Based Practice Center to prepare the CER with input from a Technical Expert Panel. This advisory panel was comprised of experts in different specialties, including sports medicine, preventative medicine, physical therapy, internal medicine, and orthopedic surgery. The panel identified important issues, reviewed proposed methods, defined parameters for the review of evidence, and helped develop the draft report.
Add to tray Remove from tray

The CER Development Process (1)

Keywords: comparative effectiveness | topic nomination | stakeholder | technical expert panel | research process
The CER Development Process (2) A comprehensive systematic review of the literature was then conducted from 12 electronic databases (1990 to September 2009), grey literature, trial registries, and reference lists. Controlled and uncontrolled studies that assessed nonoperative or operative treatments or postoperative rehabilitation for adults with confirmed rotator cuff tears were included. All methods used in the review followed version 1.0 of the Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews published by AHRQ (draft available at: http://effectivehealthcare.ahrq.gov/repFiles/2007_10DraftMethodsGuide.pdf). The draft CER was prepared and published online and was subject to public comment and peer review to improve the final product. Once finalized, the complete report was published on the Effective Health Care Program Web site (available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=467) and in the Annals of Internal Medicine (abstract available at: http://www.ncbi.nlm.nih.gov/pubmed/20621893).
Add to tray Remove from tray

The CER Development Process (2)

Keywords: comparative effectiveness | methods | peer review | research process
Clinical Questions Addressed by the CER The clinical questions that were addressed by the CER evaluated the comparative effectiveness of patient-related outcomes from included studies on: early vs. late operative intervention, nonoperative vs. operative interventions, nonoperative interventions, operative interventions, postoperative rehabilitation, as well as comparative harms from operative and nonoperative interventions and prognostic factors.
Add to tray Remove from tray

Clinical Questions Addressed by the CER

Keywords: harms | nonoperative | operative | outcomes | postoperative rehabilitation | prognostic factors | rotator cuff tear | comparative effectiveness
Pages: [1] 2 3 4 Next
 
 
 
 
www.ahrq.gov AHRQ Home | Questions? | Contact AHRQ | Site Map | Accessibility | Privacy Policy | Freedom of Information Act | Disclaimers
U.S. Department of Health & Human Services | The White House | USA.gov: The U.S. Government's Official Web Portal

Agency for Healthcare Research and Quality • 540 Gaither Road Rockville, MD 20850 • Telephone: (301) 427-1364