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An early, intensive and complementary aquatic rehabilitation protocol after arthroscopy rotator cuff repair: consensus through a Delphi study Cover

An early, intensive and complementary aquatic rehabilitation protocol after arthroscopy rotator cuff repair: consensus through a Delphi study

Open Access
|Apr 2023

Figures & Tables

Calculation of the expert competence coefficient (K)

ParticipantsKc*Ka**K***
E10.910.95
E20.810.9
E30.910.95
E4111
E5111
E60.90.90.9
E70.90.90.9
E80.910.95
E90.70.90.8
E100.70.80.75
E110.80.80.8
E120.910.95

Summary table of responses to the second round of the Delphi study

2nd roundParticipant response/(Percentage answers)

QuestionStrongly agreeAgreeNeutralDisagreeStrongly disagreeConsensus reached
15 (45.45%)3 (27.27%)3 (27.27%) 72.72%
28 (72.72%)3 (27.27%) 100%
34 (36.36%)3 (27.27%)4 (36.36%) 63.63%
43 (27.27%)2 (18.18%)2 (18.18%)3 (27.27%)1 (9.09%)45.45%
52 (18.18%) 1 (9.09%)4 (36.36%)4 (36.36%)18.18%
63 (27.27%)3 (27.27%)3 (27.27%)2 (18.18%) 54.54%
75 (45.45%)3 (27.27%)1 (9.09%)2 (18.18%) 72.72%
86 (54.54%)4 (36.36%) 1 (8.33%)90.90%
95 (45.45%)5 (45.45%) 1 (8.33%)90.90%
108 (72.72%)3 (27.27%) 100%
113 (27.27%)4 (36.36%)1 (9.09%)3 (27.27%) 63.63%
128 (72.72%)1 (9.09%) 1 (9.09%)1 (9.09%)81.81%

Summary table of the protocol agreed upon by the experts through a Delphi study_ An early, intensive, and complementary aquatic rehabilitation protocol after arthroscopy rotator cuff repair

Initial valuation_ ROM (passive)Valuation at the beginning of the first session
Beginning of the protocol_Start on the 2nd or 3rd week * after surgery* According to the decision of the surgeon and healing of the incisions. Possibility to start earlier with waterproof dressings to prevent contact with water with surgical incisions prior to complete healing
Duration of the protocol_Three weeks
SessionsAquatic sessions:
  • _three sessions per week –

  • _30-minute work per session

Land-based sessions:
  • _2 rehabilitation sessions a week at the hospital / medical center following his working protocol

TargetsFirst week of aquatic therapy
  • _Contact with the aquatic environment.

  • _Take confidence with the aquatic environment.

  • _Increase security in performing the exercises.

  • _Do the exercises suggested correctly.

  • _Understand work safety slogans for integrity of tendon repair and follow them appropriately. To promote the mobility of the glenohumeral joint in the different planes of the space within the rule of non-pain.

Remind the patient to perform the exercises and guidelines given by the hospital / medical center rehabilitation service at home
2nd and 3rd week of aquatic therapy
  • _Favor the mobility of the glenohumeral joint in the different spatial planes.

  • _Increasing the amplitude of movements always within the rule of non-pain.

  • _Promote the elasticization of the tissues that make up the joint capsule through different movements in different spatial planes.

Work instructions
  • PATIENT ACTIVITIES: _Perform active movements in all spatial directions

  • CONSIGNES:

  • _Active movements in all directions of space with the maximum possible amplitude, at low speed and within the rule of no pain.

  • _ Control the position of the GH avoiding his rise.

  • _Mainly monitor the movement in ADD + Flexion and forced external rotation.

  • PHYSIOTHERAPEUTIC WORK: _Control the patient's adaptation to the aquatic environment.

  • _Check the correct execution of the exercises.

  • _Give clear and understandable instructions

  • _Start the sessions with the patient's body leaning forward and with the shoulder covered by the water and performing active pendulum movements.

  • _Continue the session in standing position (shoulders covered by the water) with flexion-extension active movements in a neutral position of the GH joint. _Continue with flexion-extension movements gradually increasing GH ABD by 0 to 60 degrees.

  • _Continue with movements describing circles of medium and small amplitude depending on each patient in a neutral position, between 30 and 45 degrees of flexion. Bilateral direction of the circles. Gradually increase the diameter of the circles.

  • _Add motions by describing an infinite or continuous „8” motion.

  • _Add exercises by drawing figures or writing words.

Final valuation_ ROM (passive)Valuation at the end of the last session (session 9)

Summary table of responses to the 1st wave of the Delphi study

1st waveParticipant response / (Percentage answers)

QuestionStrongly agreeAgreeNeutralDisagreeStrongly disagreeConsensus reached
17 (58.31%)4 (33.32%)1 (8.33%) 91.63%
25 (41.65%)6 (49.98%) 1 (8.33%) 91.63%
36 (49.98%)3 (24.99%)2 (16.66)1 (8.33%) 74.97%
43 (24.99%)5 (41.65%)3 (24.99%)1 (8.33%) 66.64%
54 (33.32%)5 (41.65%)3 (24.99%) 74.97%
62 (16.66%)7 (58.31%)2 (16.66%)1 (8.33%) 74.97%
710 (83.33%)1 (8.33%)1 (8.33%) 91.63%
83 (24.99%)3 (24.99%)3 (24.99%)2 (16.66%)1 (8.33%)49.98%
910 (83.33%)2 (16.66%) 100%
1010 (83.33%)2 (16.66%) 100%
116 (49.98%)2 (16.66%)2 (16.66%)2 (16.66%) 66.64%
123 (24.99%)2 (16.66%)2 (16.66%)5 (41.65%) 41.65%
136 (49.98%)5 (41.65%)1 (8.33%) 91.63%
146 (49.98%)5 (41.65%)1 (8.33%) 91.63%
159 (74.97%)3 (24.99%) 100%
169 (74.97%)2 (16.66%)1 (8.33%) 91.63%
1710 (83.33%)2 (16.66%) 100%
185 (41.65%)6 (49.98%)1 (8.33%) 91.63%
199 (74.97%)2 (16.66%)1 (8.33%) 91.63%
205 (41.65%)4 (33.32%)2 (16.66%)1 (8.33%) 74.97%
219 (74.97%)2 (16.66%)1 (8.33%) 91.63%
229 (74.97%)3 (24.99%) 100%
235 (41.65%)6 (49.98%)1 (8.33%) 91.63%
2410 (83.33%)1 (8.33%)1 (8.33%) 91.63%
257 (58.31%)5 (41.65%) 100%
2612 (100%) 100%
272 (16.66%)8 (66.64%)2 (16.66%) 83.30%

Summary of the answers to the socio-demographic questionnaire of the participants in the Delphi study

ParticipantsSocio-Demographical Questions
AgeGenderEducation – main studiesCurrent professional jobYears dedication water rehabilitation/investigation Average: 20.27/SD: 9.80Specialized course in water rehabilitation
P165MaleDegreeCEO Aquatic therapy company42Bath hydrotherapy and Valens aquatic therapy course
P253FemMasterPhysical therapist16Aquatic Therapy University Aquaticist
P341FemPhDPhysiotherapist rehabilitator and university teacher20Therapeutic swimming, Specific water therapy, Halliwick, Watsu TCSA, Water therapy in ASD
P434FemMasterInjury rehabilitator and physical trainer at the pool and gym10Teaching specialized courses in the recovery of injuries in the aquatic environment
P562FemPhD CandidateDirector of hydrotherapy department40Several: Advanced Hydrotherapy, Watsu, halliwick, Bad Ragaz, neurology, Pediatrics…
P657FemPhDPhysiotherapist in hospital20Several in: IATF and GIFA-APFISIO
P740FemPhDPhysiotherapist21Halliwick
P848FemDegreePTA6Certification from Aquatic Therapy University
P963MalePhDTeacher35No. I’ve created a method of a aquatics therapy
P1040FemDegreePhysiotherapist15Several (Bad ragaz, halliwick, ai-chi, therapeutic swimming, watsu, expert technician in aquatic therapy
P1141FemDegreePhysiotherapy20No
P1257FemPhDInvited teacher, physioterapist on hospital20Several: in switzerland and Portugal. I’m IATF member
Language: English
Page range: 49 - 60
Submitted on: Nov 16, 2022
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Accepted on: Mar 22, 2023
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Published on: Apr 4, 2023
In partnership with: Paradigm Publishing Services

© 2023 Marc Capdevila-Pons, Gil Pla-Campas, Xavier Gironès, published by University of Physical Education in Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.