Pediatric Shoulder Rehabilitation

Objectives:
As a result of increased participation in competitive sports, shoulder instability, subluxations, and dislocations are common injuries in the adolescent athlete. These injuries worsen when athletes over train, make physical contact, and do not take enough time for rest between injuries. Protocols and therapies need to be implemented to prevent subsequent injuries, including progressive measurement of rehabilitation and return to play (RTP) outcomes. The goal of treatment for these athletes is to return them to their previous level of performance and prevent re-injury.

The purpose of this quality improvement evidence-based project was to determine if the use of the Pediatric Adolescent Shoulder Survey (PASS) affects return to play. The aims of this project were to determine if there was a change in return to play (RTP) outcomes, compare length of RTP between operative and non-operative groups, and determine if PASS scores improved over time.

Methods:
The PASS is a 13 item, patient reported outcomes (PROs) survey assessing symptoms, limitations, compensatory mechanisms, and emotional distress. It is reliable and valid for athletes who have acute shoulder injuries and decreased range of motion or strength.

After obtaining Institutional Review Board (IRB) approval from the institution and university, providers at a southwestern sports medicine clinic were educated on administration and scoring of the survey. Surveys were administered to athletes ages 8-18 who presented with shoulder injuries at intervals. Retrospective and prospective chart reviews were obtained at baseline (control group) and post intervention (intervention group). Return to play (RTP) days and Pediatric Adolescent Shoulder Survey scores were recorded.

Results:
Independent t-tests were calculated to compare mean RTP days from control and intervention groups, RTP for operative and non-operative groups within the control and intervention groups. Statistically significant t (20) = -2.827, p = 0.03) differences were noted between operative group for the intervention group, (n=9), M=136.00 (SD=51.49) days vs non-operative group, M= 83.68 (SD=31.78) days. No statistically significant difference between control group M =118.68 (SD=55.95) days and intervention group M=107.52 (48.77) days was noted. PASS scores showed improvement over time.

Conclusion:
The PASS instrument may positively affect RTP. There was a significant change in RTP for the whole group. Non-operative patients RTP sooner than operative for the whole sample. PASS scores improved over time for all patients.