SPRING

We aim to co-design prehabilitation and early rehabilitation interventions for people undergoing total shoulder replacement and test the clinical and cost-effectiveness of these interventions, in comparison to usual care, in improving function and reducing pain.

Background

More and more people in the UK are having surgery to replace their shoulder joints because of painful arthritis or shoulder damage that makes it difficult for them to conduct everyday activities. It can take more than 6 months and sometimes over a year for people to recover from this surgery. In the early months after surgery, people need a lot of help with washing, dressing and self-care and may need to wear a sling.

Prehabilitation

Supportive treatments either before (prehabilitation) or after surgery (rehabilitation) are critical. We know that people who receive prehabilitation and are mentally and physically prepared for surgery (any type) seem to do better as they recover. We also know that if people start rehabilitating as soon as they can after surgery, they seem to have fewer problems and recover quicker. However, prehabilitation is not offered routinely and many people struggle to access rehabilitation and when they do it may not meet their specific needs. We don't know what type of prehabilitation or rehabilitation works best for people who have shoulder replacement surgery.

Study aims

In the SPRING study, we will work with people who have had shoulder replacements and healthcare practitioners who have experience of shoulder replacement surgery to develop two new treatments. This will give people requiring the surgery, knowledge, confidence and skills to make (shared) decisions and take action about their care and to navigate their shoulder replacement journey in a way which suits their needs.

Study design

We will hold interviews with people who have undergone or who are preparing to have a shoulder replacement to help us develop prehabilitation and early rehabilitation treatments. It is important to us that the needs of different people (varied ethnic and social groups and people from across the UK) are represented in our treatments so we will ensure they are included in our development activities.

We will ask professionals such as physiotherapists, occupational therapists, nurses and orthopaedic surgeons about their ideas, and ask for suggestions on how to embed these ideas into treatments. We will trial the treatments with a small group of participants and practitioners across the UK. Once the new treatments are finalised, we will test if they work with about 390 adults who have been referred for shoulder replacement in England, Northern Ireland and Wales. We will use a randomised design, by which we mean that people who agree to take part will receive either the care they would normally get in the NHS or one of the two new treatments. We will measure pain and ability to carry out daily activities before and after receiving their different treatments and will continue to do these measurements for twelve months after shoulder replacement. We will check that our new treatments are safe, that people can follow the treatments and that they are delivered by the health professionals in the way we would expect.

The Centre for Trials Research is working on this together with Cardiff University School of Healthcare Sciences.