Rehabilitation for atraumatic shoulder instability in circus arts performers: delivered via telehealth

      Background: The Watson Instability Program (WIP1) is the highest level of evidence for the conservative management of atraumatic shoulder instability, but it is unknown if this program can be effectively delivered via teleconsultation. The aim of this study observational single cohort study was to determine the effects of the WIP1 on patient reported outcome measures, scapula position, shoulder strength and handstand stability in student circus performers with atraumatic shoulder instability, when delivered via teleconsultation.
      Methods: Student circus performers aged between 15 and 35 from the National Institute of Circus Arts were recruited. A 12-week shoulder exercise program was delivered via teleconsultation during the Melbourne, Australia Covid-19 lock-down. Primary outcome measures were the Western Ontario Shoulder Index and the Melbourne Instability Shoulder Score. Secondary outcomes measures included the Orebro Musculoskeletal Pain Questionnaire, The Tampa Scale for Kinesiophobia and physical assessment measures including strength via hand-held dynamometry, scapula position using an inclinometer and handstand stability via center of pressure fluctuation. Patient reported outcomes were collected at baseline, 6-week, 12-week, 6-month and 9-month timepoints, and physical outcomes were measured at baseline and 9-month timepoints.
      Results: Twenty-four student circus arts performers participated in the study. Significant improvements were found for both Western Ontario Shoulder Index, Melbourne Instability Shoulder Score (p<0.001) and Orebro Musculoskeletal Pain Questionnaire scores (p<0.01) at all follow up timepoints. The Tampa Scale for Kinesiophobia scores reached significance at 6-weeks and 3-months (p<0.05). Following rehabilitation, statistically significant increases in shoulder strength in all positions tested and increased scapula upward rotation measured at end of range abduction, and during loaded external rotation were found. Prior to rehabilitation, the affected arm showed greater instability compared to the unaffected arm during handstand. Post-rehabilitation, a significant intervention effect existed for the affected arm, showing greater consistency in anterior-posterior movement pattern.
      Discussion: The WIP1 is an effective program for improving shoulder symptoms and physical function in individuals with atraumatic shoulder instability. Though it cannot be confirmed if outcomes are equivalent to that of face-to-face delivery.
      Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.