Home-based versus outpatient rehabilitation after shoulder arthroplasty
Shoulder & Elbow · 19 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Postoperative therapy after shoulder replacement is costly and burdensome for older patients, and these trials suggest a surgeon-directed home programme may yield similar 1-year outcomes after reverse shoulder arthroplasty.
The evidence
This systematic review and meta-analysis pooled nine randomised trials (793 patients), mostly in reverse total shoulder arthroplasty, comparing rehabilitation approaches: home-based or telerehabilitation versus outpatient physical therapy, early versus delayed mobilisation, and added subscapularis training. At 1 year, home-based rehab and outpatient PT showed no significant difference in ASES score (mean difference -0.84 points, 95% CI -4.63 to 2.94), range of motion, or pain. Early mobilisation improved forward flexion at 3 months in one trial, but the gain disappeared by 6 months, and subscapularis-specific exercises added nothing.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Meta-analysis of RCTsDesign starting point: 60.8
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
No negative adjustments recorded.
Score capped at 40. The conclusions are not supported by the reported results.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedNot met
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 60.8
- Compared against current standard of care
- +3.4
- Prospectively registered
- +5.1
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Methodological cap
- −45.4
- Final rigour score rounded
- 40 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Which reverse shoulder arthroplasty patients (for example those with poor bone quality, frailty, or limited digital access) would you still route to supervised outpatient physical therapy rather than a home programme?
2.After an anatomic TSA with lesser tuberosity osteotomy, how would you counsel a patient who wants early motion to regain function faster, given the transient flexion gain and the possible effect on osteotomy healing?
Original publication title
Effects of different postoperative rehabilitation approaches following shoulder arthroplasty: A systematic review and meta-analysis