| Objective:To establish staged Daoyin rehabilitation protocol following arthroscopic rotator cuff repair based on surface electromyographical(sEMG)analysis of selected shoulder muscles during Shi’s twelve-word life cultivation skill exercises;To evaluate the efficacy and safety of Daoyin rehabilitation protocol by performing prospective casecontrol study and musculoskeletal ultrasound based supraspinatus morphological study.Methods:The first part:Electromyographical Analysis of Selected Shoulder Muscles during Daoyin ExercisesTen healthy volunteers were enrolled to practice Shi’s twelve-word life cultivation skill.Surface electrodes were used to record EMG activity from selected shoulder muscles(supraspinatus,infraspinatus,anterior deltoid,middle deltoid,posterior deltoid)during 12 movements of Shi’s twelve-word life cultivation skill.Percentage of maximum voluntary isometric contraction(%MVIC)were used to normalize the EMG activation levels of muscles and the movements of<10%MVIC were considered as passive rehabilitation exercises.Then staged Daoyin rehabilitation protocol following arthroscopic rotator cuff repair were established.The second part:Clinical Study of Daoyin Therapy for Early Rehabilitation following Arthroscopic Rotator Cuff RepairPatients,who underwent arthroscopic rotator cuff repair for small or median supraspinatus tear were enrolled and randomized into two groups.The control group received conventional rehabilitation protocol only,while the study group received staged Daoyin therapy in addition to conventional rehabilitation.Both groups were assessed at five time points:4 weeks,2 months,3 months and 6 months post-operation.The efficacy measures included American shoulder and elbow surgeons shoulder score(ASES Shoulder Score),Visual Analog Scale(VAS),Pittsburgh Sleeping Quality Index(PSQI),the 12 Items Short Form Health Survey(SF-12)which included Physical Component Summary(PCS)and Mental Component Summary(MCS).Complications of both groups were also recorded.All the measures were compared between groups with corresponding statistic methods.The third part:A Musculoskeletal Ultrasound Study of Supraspinatus Morphology in Two Different Rehabilitation Protocols following Arthroscopic Rotator Cuff RepairPatients,who underwent arthroscopic rotator cuff repair for small or median supraspinatus tear were enrolled and randomized into conventional rehabilitation group and Daoyin rehabilitation group.Cross-sectional area of supraspinatus muscle was measured with musculoskeletal ultrasound at 4 weeks,2 months,3 months and 6 months post-operation.And the retear of supraspinatus tendon was assessed with musculoskeletal ultrasound at 3 and 6 months post-operation.Results:The first part:Electromyographical Analysis of Selected Shoulder Muscles during Daoyin ExercisesThe supraspinatus was activated<10%MVIC during six movements of Shi’s twelve-word life cultivation skill,including washing the face,combing the hair,kneading the ears,relaxing the neck,turning the waist and rotating the knee,which could be applied in the first stage rehabilitation following rotator cuff repair.However,the infraspinatus was activated>10%MVIC during combing the hair and turning the waist(11.21±0.86 and 18.68±1.23%MVIC,respectively),which should be carefully used in those who had a supraspinatus tendon tear combination with or adjacent to infraspinatus tendon.The supraspinatus was activated>10%MVIC during the rest six movements which should be applied from the second stage.The second part:Clinical Study of Daoyin Therapy for Early Rehabilitation following Arthroscopic Rotator Cuff RepairA total of 125 patients were enrolled and 118 of them completed the followup,with 58 in the conventional rehabilitation group and 60 in the Daoyin rehabilitation group.The ASES shoulder score,SF-12 PCS and MCS of Daoyin rehabilitation group were significantly better than that of conventional rehabilitation group in the early post-operative period(4 weeks,2 months)(P<0.05),however there were no statistical difference in later follow-up time points.PQSI of Daoyin rehabilitation group was significantly better than that of conventional rehabilitation group in all follow-up time points(P<0.05).VAS of Daoyin rehabilitation group was also significantly better than that of conventional rehabilitation(P<0.01).The third part:A Musculoskeletal Ultrasound Study of Supraspinatus Morphology in Two Rehabilitation Protocols following Arthroscopic Rotator Cuff RepairA total of 89 patients were enrolled and 81 of them completed the follow-up,with 41 in the conventional rehabilitation group and 40 in the Daoyin rehabilitation group.The cross-sectional area of supraspinatus muscle of Daoyin rehabilitation group were significantly better than that of conventional rehabilitation group at all follow-up points(P<0.05).In addition,the muscle area exceeded that of preoperation at 2 months post-operation in the Daoyin rehabilitation group,while the same target was achieved till 6 months post-operation in the conventional rehabilitation group.No significant difference was found in retear rate between two rehabilitation groups.Conclusion:1.According to the sEMG movement analysis,Shi’s twelve-word life cultivation skill could be safely applied in the early rehabilitation following rotator cuff repair by staged implementation.Six movements,including washing the face,combing the hair,kneading the ears,relaxing the neck,turning the waist and rotating the knee,could be applied in the first stage.The rest six movements should be applied from the second stage.2.Compared with conventional rehabilitation protocol,Daoyin rehabilitation protocol could significantly improve the patients’ rehabilitation efficiency and overall quality of life following arthroscopic rotator cuff repair.3.Musculoskeletal ultrasound based study revealed that Daoyin rehabilitation protocol could significantly reduce the degree and duration of supraspinatus disuse atrophy following rotator cuff repair without increasing the risk of rotator cuff retear. |
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