Summary

Utilization of the Shoulder Strengthening and Stabilization Systems (SSS) offers cost savings and additional patient autonomy with home-based PT during the first 6 weeks of recovery after rotator cuff repair.

Abstract

Background

Following arthroscopic rotator cuff repair (RCR), physical rehabilitation is crucial to optimizing outcomes. The Shoulder Strengthening and Stabilization Systems (SSS) combines telemedicine with a home-based machine that facilitates shoulder range of motion (ROM) exercises during rehabilitation following shoulder surgery. Notably, prior studies have found no difference in clinical outcomes between rehabilitation using the SSS vs SSS + PT vs PT alone in the first 6 weeks after rotator cuff repair. We hypothesized that utilization of SSS would be a cost-effective and patient focused physical therapy option that reduced overall PT visits.

Methods

This study compared the cost effectiveness of using the SSS system following RCR among the following 3 cohorts: SSS alone in the first 6 weeks, SSS + formal PT in the first 6 weeks, and formal PT alone without SSS. All groups completed formal physical therapy after the 6-week mark. Physical therapy visits of an initial cohort of 441 patients undergoing PT after rotator cuff repair (184 in the formal PT without SSS group, 63 in the SSS alone group, 194 in the SSS and PT group) were reviewed, recording the cost of each individual PT session. Exclusion criteria included patients who completed physical therapy at a 3rd party or out of network provider, due to absent data, and physical therapy sessions that occurred prior to the date of surgery.

Results

A total of 234 patients were included for analysis (103 in the formal PT without SSS group, 42 in the SSS alone group, 89 in the SSS and PT group). The missing patient data did not differ between the three groups (p = 0.06). The average number of PT visits for each group statistically differed (p = 0.0052) with SSS group undergoing the least number of visits (median: 22.5 IQR: 15-35), following the PT alone group (median: 25.5 IQR: 18.5 - 38), with SSS in combination with PT during the first 6 weeks undergoing the most number of visits (median: 30.5 IQR: 24 – 41.5). The average total charge amount per PT visit was $179, translating to a total average difference between SSS alone and PT alone of $537, and to a total average difference between SSS and SSS in combination with early PT of $1,433.

Conclusion

In the setting of literature showing high patient satisfaction (93%) and improvement in patient pain and stiffness in the early preoperative period, SSS offers cost savings in decreased total PT visits during recovery, with an averaged $537 decrease, when compared to PT alone. It additionally increases patient autonomy with home-based PT during the first 6 weeks of recovery.