Health Problem: Joint contractures refer to a decreased range of motion (ROM) in diarthrodial (or movable) joints. Contractures may occur with joint disease, trauma, or healing, or secondarily to structural changes in muscle, tendons, ligaments, and/or skin that limit elasticity. Immobilization of a joint may create conditions that contribute to the development of contractures. During immobilization, collagen weakens and becomes less organized, which can lead to the formation of joint adhesions. For shoulders, surgical repair of the rotator cuff presents a risk of contracture during postoperative healing.

Technology Description: Continuous passive motion (CPM) allows for passive motion therapy to be provided in a controlled manner, which may complement other types of physical therapy (PT). CPM involves the use of a motorized device that moves the affected joint through a prescribed arc of motion for an extended period of time without any active muscle contraction. These devices are intended to complement or replace some physical therapist–directed sessions by providing frequent and consistent application of joint mobilization under controlled conditions in a hospital or in the patient’s home. There are a wide range of protocols for the use of CPM as part of a rehabilitation program, and optimal treatment parameters for various indications are not clearly established.

Controversy: Despite widespread use, it is unclear whether CPM provides any benefit over immobilization, manual passive mobilization, and/or other rehabilitative protocols. Furthermore, the optimal frequency and duration of CPM treatments for various indications are not clear.

Key Questions:  

  • Does adjunct CPM improve clinical outcomes during immediate postoperative rehabilitation following rotator cuff repair or for treatment of adhesive capsulitis compared with alternative rehabilitation strategies such as PT or immobilization?
  • What complications are associated with CPM?
  • Have definitive patient selection criteria been established?

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