Rehabilitation outcomes after proximal humeral fracture: An observational study

Abstract

BACKGROUND AND PURPOSE: Fractures of the proximal humerus are characterised by slow recovery and ongoing disability. We aimed to describe the recovery of patients referred to community physiotherapy after proximal humeral fracture and determine if activity thresholds based on the Shoulder Function Index (SFInX) could inform physiotherapist decision-making. METHODS: Using a prospective observational cohort design, patients referred to community rehabilitation for physiotherapy were assessed for activity limitation (SFInX, DASH), quality of life (EQ-5D), pain levels (VAS), global rating of change, and shoulder range of movement at weeks 0, 6, 12 and 26. A focus group explored treating physiotherapists’ perceptions of using the SFInX. Characteristics of participants meeting SFInX clinically meaningful activity thresholds (+Δ17 units, score ≥73 units) were compared to those who did not. RESULTS: Participants (n = 38, mean age 78 years, 29 women, 29 conservatively managed) commenced physiotherapy a median of 12 (min 4, max 62) weeks after proximal humeral fracture and received a median of 8 (min 3 max 17) sessions over 8 weeks. N = 18 achieved +ΔSFInX ≥17 units by week 6. N = 15 achieved SFInX ≥73 units by week 26. Shoulder flexion range of 112° predicted +ΔSFInX ≥17 units at week 6 (AUC 0.74, 95% CI 0.58 to 0.90). Physiotherapists reported not basing management decisions on the SFInX. CONCLUSIONS: Patients after proximal humeral fracture make clinically meaningful improvements in shoulder activity after referral to physiotherapy. Decision-making based on SFInX activity thresholds or achievement of shoulder flexion of at least 112° may be informative but physiotherapists preferred making decisions based on individual goal-attainment.