Table 3 Data analysis, overall (Sections 1, 2, 3)

Section 1 | Shoulder replacement rehabilitation -general question-

 How important do you think patient education is for a good functional recovery after shoulder replacement? (Q8)

I do not know

5

0.8

0.1–1.5

Not very important

4

0.7

0.0–1.3

Relatively important

61

10.0

7.7–12.4

Very important

537

88.5

85.9–91.0

 In your clinical practice, how do you manage pain and swelling in the immediate post-operative period after shoulder replacement (0–3 weeks)? (Q9)

Cautious passive joint mobilization and introduction of gentle active joint exercises

15

2.5

1.2–3.7

Patient education and cautious passive joint mobilization

64

10.5

8.1–13.0

Patient education, ice, treatment of oedema, cautious passive joint mobilization and introduction of gentle active joint exercises

503

82.9

79.9–85.9

Patient education and treatment of oedema

25

4.1

2.5–5.7

 In your clinical practice, which treatment strategies do you mainly prefer during rehabilitation of a patient with TSA? (Q10)

Aquatic therapy

31

5.1

3.4–6.9

Modalities (e.g., electrotherapy, laser therapy, diathermy)

1

0.2

-0.2–0.5

Manual therapy and therapeutic exercise with progressive load

404

66.6

62.8–70.3

Manual therapy and therapeutic exercise with progressive load, modalities

171

28.2

24.6–31.7

 In your clinical practice, do you use self-reported outcome measures (self-assessment questionnaires that are filled indirectly by the patient, e.g., DASH) at the beginning and/or end of the rehabilitation treatment after shoulder replacement? (Q11)

No

303

49.9

45.9–53.9

I don’t know any

27

4.4

2.8–6.1

Yes, sometimes

195

32.1

28.4–35.8

Yes, always

82

13.5

10.8–16.2

 In your clinical practice, which non-self-reported outcome measures (measures for which the operator observes a certain variable and assigns a score, e.g., ROM) do you mainly use to record the obtained results from the treatment of patients after shoulder replacement? (Q12)

Strength assessment

3

0.5

-0.1–1.1

aROM assessment

69

11.4

8.8–13.9

pROM assessment

26

4.3

2.7–5.9

All previous answers

509

83.9

80.9–86.8

Section 2 | Rehabilitation after TSA

 Which movement is important to avoid, as to prevent TSA dislocation? (Q13)

Shoulder abduction and external rotation

264

43.5

39.5–47.4

Shoulder adduction and internal rotation

87

14.3

11.5–17.1

End-range shoulder anterior flexion

21

3.5

2.0–4.9

Shoulder internal rotation, adduction and extension

235

38.7

34.8–42.6

 In your clinical practice, how do you manage pROM recovery in patients with TSA? (Q14)

pROM from 4th up to 8th week with shoulder forward flexion and external rotation movements

25

4.1

2.5–5.7

pROM from 8^th up to 12^th week with progression, according to patient’s tolerance

148

24.4

21–27.8

pROM up to first 6 weeks, with shoulder forward flexion, abduction, internal rotation and 15°-30° limit of external rotation; full pROM in all direction of movements from 6 to 12^th week

377

62.1

58.3–66

pROM up to first 6 weeks, in all direction of movements; full pROM at 6^th week

57

9.4

7.1–11.7

 In your clinical practice, how do you manage aROM recovery in patients with TSA? (Q15)

aROM < 90° of shoulder forward flexion and abduction at 3–4 weeks; aROM > 90° from 6 to 12^th weeks;full aROM at 3 months

268

44.2

40.2–48.1

assisted aROM with pulley up to first 4 weeks; aROM of shoulder forward flexion from 4 to 8^th week; full aROM in all directions of movement with tolerance from 8 to 12^th week

147

24.2

20.8–27.6

assisted aROM for 6 weeks; full aROM in all directions of movement at 9 weeks

44

7.2

5.2–9.3

assisted aROM for 6 weeks; full aROM at 3 months

148

24.4

21–27.8

 In your clinical practice, when do you introduce isometric exercise in patients with TSA? (Q16)

0–3 weeks

275

45.3

41.3–49.3

4–6 weeks; isometric contraction of scapular muscles and distal forearm muscles; isometric contraction in internal and external rotation from 6 to 10^th week

188

31.0

27.3–34.7

4–6 weeks

123

20.3

17.1–23.5

5–10 weeks

21

3.5

2.0–4.9

 In your clinical practice, when do you think it is necessary to start with progressive muscle strengthening in patients with TSA? (Q17)

6–8 weeks

220

36.2

32.4–40.1

9–12 weeks

105

17.3

14.3–20.3

Over 12 weeks

23

3.8

2.3–5.3

According to patient’s joint recovery

259

42.7

38.7–46.6

 Which of these muscles are a priority during strengthening phase in patients with TSA? (Q18)

Scapular muscles

11

1.8

0.8–2.9

Scapular muscles and rotator cuff muscles

113

18.6

15.5–21.7

Scapular muscles and deltoid

84

13.8

11.1–16.6

Scapular muscles and rotator cuff muscles, deltoid, biceps, triceps

399

65.7

62–69.5

 What is the most common complication that can occur following TSA surgery? (Q19)

Infection

63

10.4

8–12.8

Instability of the glenoid prosthetic component

201

33.1

29.4–36.9

Failure of the subscapularis tendon

153

25.2

21.8–28.7

Dislocation

190

31.3

27.6–35.0

 In your clinical practice, following TSA surgery, when should the patient be instructed to mainly return to ADLs (e.g. washing, dressing, combing their hair, cooking) (Q20)

6–9 weeks

55

9.1

6.8–11.3

9–12 weeks

71

11.7

9.1–14.3

 > 12 weeks

32

5.3

3.5–7.0

From week 6 onwards, depending on the patient’s recovery (pain reduction, ROM recovery) and the specificity of each activity^a

449

74.0

70.5–77.5

 In your clinical practice, following TSA surgery, when do you expect the patient to be able to return to sport? (in details: involving the upper limb, non-contact sport and non-throwing sport) (Q21)

6–12 weeks

19

3.1

1.7–4.5

13–24 weeks

167

27.5

24.0–31.1

7 months–1 year

340

56.0

52.1–60.0

Over a year

81

13.3

10.6–16.0

Section 3 | Rehabilitation after RTSA

 Which movement is important to avoid, as to prevent RTSA dislocation? (Q22)

Shoulder abduction and external rotation

182

30.0

26.3–33.6

Shoulder abduction and internal rotation

65

10.7

8.2–13.2

End-range shoulder anterior flexion

35

5.8

3.9–7.6

Shoulder internal rotation, adduction and extension

325

53.5

49.6–57.5

 In your clinical practice, how do you manage pROM recovery in patients with RTSA? (Q23)

pROM up to first 6 weeks, with 90°-120° shoulder forward flexion and till 30°external rotation with tolerance; full pROM from 6 to 12^th week

300

49.4

45.4–53.4

pROM from 8^th up to 12^th week with progression, depending on patient’s tolerance

116

19.1

16.0–22.2

pROM up to first 6 weeks; full pROM from 6 to 12^th week, included full shoulder external rotation

128

21.1

17.8–24.3

No pROM in the first 6 weeks; pROM shoulder movements with tolerance after 6 weeks

63

10.4

8.0–12.8

 In your clinical practice, how do you manage aROM recovery in patients with RTSA? (Q24)

aROM till 90°shoulder forward flexion and 30° external rotation in the first 6 weeks; aROM till 90° of shoulder forward flexion till 12^th week; full aROM with tolerance from 12 to 16^th week

216

35.6

31.8–39.4

aROM till 120° shoulder forward flexion and 30° external rotation in the first 6 weeks; full aROM over 6 weeks

30

4.9

3.2–6.7

aROM in all direction of movements with tolerance from 6^th week; full aROM from 12 to 16^th week

119

19.6

16.4–22.8

Hand, wrist and elbow aROM maintenance up to first 6 weeks; full aROM from 12 to 16^th week with progression, according to patient’s tolerance

242

39.9

36.0–43.8

 In your clinical practice, when do you introduce isometric exercise in patients with TSA? (Q25)

0–3 weeks

249

41.0

37.1–44.9

4–6 week

159

26.2

22.7–29.7

4–6 weeks; isometric contraction of scapular muscles and distal forearm muscles; isometric contraction in internal and external rotation from 6 to 10^th week

163

26.9

23.3–30.4

 > 6 weeks

36

5.9

4.1–7.8

 In your clinical practice, when do you think it is necessary to start with progressive muscle strengthening in patients with RTSA? (Q26)

6–8 weeks

222

36.6

32.7–40.4

9–12 weeks

119

19.6

16.4–22.8

Over 12 weeks

48

7.9

5.8–10.1

According to patient’s joint recovery

218

35.9

32.1–39.7

 Which of these muscles are a priority during strengthening phase in patients with RTSA? (Q27)

Deltoid

77

12.7

10–15.3

Rotator cuff muscles

85

14.0

11.2–16.8

Scapular muscles

32

5.3

3.5–7.0

Deltoid and scapular muscles

413

68.0

64.3–71.7

 What is the most common complication that can occur following RTSA surgery? (Q28)

Scapular notch erosion

258

42.5

38.6–46.4

Acromial fracture

76

12.5

9.9–15.2

Infection

56

9.2

6.9–11.5

Dislocation

217

35.7

31.9–39.6

 In your clinical practice, following RTSA surgery, when should the patient be instructed to mainly return to ADLs (e.g. washing, dressing, combing their hair, cooking) (Q29)

6–9 weeks

65

10.7

8.2–13.2

9–12 weeks

90

14.8

12–17.7

 > 12 weeks

52

8.6

6.3–10.8

From week 6 onwards, depending on the patient’s recovery (pain reduction, ROM recovery) and the specificity of each activity^a

400

65.9

62.1–69.7

 In your clinical practice, following RTSA surgery, when do you expect the patient to be able to return to sport? (in details: involving the upper limb, non-contact sport and non-throwing sport) (Q30)

6–12 weeks

24

4.0

2.4–5.5

13–24 weeks

119

19.6

16.4–22.8

7 months–1 year

283

46.6

42.7–50.6

Over a year

181

29.8

26.2–33.5