NITEP group conducted a multicenter randomized controlled trial (RCT) across Denmark, Finland, and Norway to assess the effectiveness of physiotherapist-supervised exercises versus unsupervised home-based exercises in older adults with nonsurgically treated displaced 2-part proximal humerus fractures (PHFs).
The trial included 72 patients aged ≥60 years who were randomized into two groups: (1) supervised physiotherapy once weekly for 10 weeks with daily home exercises, or (2) unsupervised daily home-based exercises. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 3 months; secondary outcomes included DASH at 12 months, Constant-Murley Score, VAS for pain, 15D health-related quality of life, Pain Catastrophizing Scale (PCS), and General Self-Efficacy Scale (GSE).
At 3 months, the mean DASH score was 25.9 (SD 16.0) in the supervised group vs. 22.4 (SD 18.9) in the unsupervised group, with a between-group difference of 3.5 points (95% CI: –5.0 to 12.5), which was neither statistically significant nor clinically meaningful. No significant differences were observed in any secondary outcomes at either 3 or 12 months. Rates of nonunion and complications (e.g., frozen shoulder, rotator cuff pathology) were low and similar between groups.
The study concludes that weekly supervised physiotherapy sessions do not provide added benefit over unsupervised home-based rehabilitation in this patient population. These findings align with previous smaller RCTs and suggest that most older adults with a nonsurgically treated 2-part PHF can safely and effectively perform rehabilitation independently when provided with structured instructions.
This evidence supports a shift toward more resource-efficient rehabilitation models without compromising outcomes, highlighting the importance of patient education and adherence to prescribed home exercise protocols.
Study was published in the Journal of Shoulder and Elbow Surgery in February 2nd. Link to the study: https://www.jshoulderelbow.org/article/S1058-2746(24)00053-3/abstract
