Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Health and Rehabilitation Sciences


Dr. Joy C. MacDermid




Rotator cuff (RC) tears are one of the common causes of pain and disability in the upper extremity. Currently there are no fixed guidelines for choosing testing positions for shoulder range of motion measurement. Optimal rehabilitation following RC repair is yet to be defined.

Purpose and Method

The purpose was to inform about postoperative Physical therapy following rotator cuff repair, with the following objectives:

  • To systematically review the content of clinical research, which addresses various physical therapy programs.
  • To describe validity and responsiveness of different testing positions for goniometric measurement of shoulder active external rotation.
  • To pilot test study procedures and estimating effects of a land-based and an aquatic exercise program.


  • Fourteen studies were included in the systematic review.
  • ROM measurements in sitting and supine positions correlated moderately (r= 0.40 - 0.53). The sitting position showed greater sensitivity to change with estimates of standardized response mean (SRM) and effect size (ES) (SRM: 0.66, 1.05 and ES: 0.50, 1.02) as compared to the supine position (SRM: 0.39, 0.74 and ES: 0.37, 0.76) at 3 and 12 months postoperatively, respectively.
  • A total of 12 patients with a 67% recruitment rate, participated. Clinic visit adherence was 95%. No one was lost to follow-up. Both land-based and land plus aquatic exercise groups showed improved flexion AROM over time (Mean change= 21°, Standard Deviation (SD)= 25° and Mean change= 22°, SD= 33° respectively). For future studies, for having 80% power (α= 0.05, β= 0.20), and to detect 20% between-group difference, a total of 33 patients per group would be needed.


  • The systematic review found that exercise therapy including adjunctive interventions has small to moderate effect.
  • 29% of the patients could not undergo active shoulder external rotation testing in supine, all patients could be tested in sitting. The sitting position has higher responsiveness than the supine position.
  • Both land-based and aquatic exercise programs are shown to be feasible. To achieve power, we recommend future studies with larger sample size.


Physical therapy, rotator cuff tear, land-based exercises, aquatic exercises, systematic review, pilot study.