The ARC Trial rehabilitation guidelines v2 - 24 April 2023 - clean

Sep 17, 2026

Rehabilitation guidelines for the ARC Trial outline a physiotherapist-led program for the first 20 weeks after surgery, structured into four phases. Phase 1 covers 4 weeks of sling immobilisation (24 hours/day except showering), patient education, elbow/hand exercises, and passive range of motion when permitted. The protocol emphasizes quality of movement, stepwise progression, individualized load adjustment, home-exercise dosing (typically 3–4 exercises), and clear pain criteria to guide readiness for progression while protecting surgical repair and minimizing stiffness.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Instructions for the Physiotherapists

Rehabilitation program structure (up to 20 weeks)

General principles for exercise performance

Phase 1 (0–4 weeks)

Rehabilitation guidelines for the ARC Trial (adapted from the ACCURATE study, rehabilitation protocol from Linköping University Hospital) . These rehabilitation program guidelines are adapted from the ACCURATE trial protocol (with permission) which is based on the current literature (Edwards et al., 2016; Holmgren, Bjornsson Hallgren, Oberg, Adolfsson, & Johansson, 2012; Klintberg et al., 2015; Ranebo, Bjornsson Hallgren, Holmgren, & Adolfsson, 2020; Thigpen et al., 2016) . The ARC trial rehabilitation guidelines have been further adapted to suit the clinical experience in the Australian setting. Instructions for the Physiotherapists Physiotherapists will be provided with the same rehabilitation guidelines covering the period up to 20 weeks following surgery. The rehabilitation program consists of the 4 phases as described in detail below, commencing with Phase 1: sling immobilisation for 4 weeks. Additionally, patients will be expected to perform home-exercises according to the different phases (see below) . The details of patient contact (e.g., number and type of visits, use of telehealth and home exercises) and exact exercises prescribed will be dictated by local practice and resources. Physiotherapists will be asked to consistently apply their rehabilitation programs for all study participants. Notes: 􀂾 Choose a maximum of 3-4 exercises during a specific time and progress to new exercises when the patient is ready with respect to quality of movement and pain. 􀂾 Consider aspects of quality of motion and pain, in accordance with restrictions to decide when patient is ready to move to the next phase. None or minimal pain (0-4/10 Numerical Rating Scale) during the exercises is one milestone to progress to the next phase. 􀂾 Patients may proceed slower through the phases but not faster for surgical protocol reasons. Exercises from previous phases can be continued even though the patient has progressed to the next phase. 􀂾 In strength phases, range of motion exercise should focus on specific deficiencies and not be additive – otherwise patients may be overwhelmed and not able to complete the routine General principles concerning the performance of exercises in the rehabilitation process 􀂾 The quality of movement is essential: If an exercise is performed incorrectly, replace it with one that is easier for the patient to perform. 􀂾 Mild pain or strain may be experienced with ROM exercises. However, patients must be educated on the types of pain that is considered unacceptable: i.e., constant pain, radiating pain or pain that lasts for an extended period after the exercises have been performed. The patient should be advised it is normal to experience soreness with strengthening exercises. 􀂾 Hands on guidance: To guide the patient with feedback from your hands is important within the PT supervised sessions. Ensure the patient performs the home-exercises correctly by demonstrating and practicing them. 􀂾 Step wise progression: The load needs to be increased in steps and with respect to shoulder pain. This aspect is considered in the different phases. 􀂾 Load: The load will be individually adjusted. If the patient feels pain, reduce the load. 􀂾 Home- exercise dosage: Home exercise program should consist of no more than 3-4 exercises. 􀂾 Dosage and progression: Recommended repetitions for each exercise is in the explanatory text attached to each exercise. Loading exercises to strengthening the muscles in phase III are performed once every other day. Exercises to restore or increase range of motion or neuromuscular control exercises, should be performed daily. If the patient experiences pain, the dosage may be reduced. Phase 1 (0-4 weeks) 􀂾 Sling immobilisation for 4 weeks, 24 hours a day except for showering; elbow and hand exercises; and passive range of motion (PROM) exercises when the sling can be removed. 􀂾 Patient education. Exercises to reduce risk of cuff/capsular stiffness and for good post

FAQs

How long does sling immobilisation last in Phase 1, and what are the key exceptions?

Sling immobilisation lasts 4 weeks, 24 hours per day except for showering.

What home-exercise dosage is recommended during the rehabilitation program?

Home exercises should consist of no more than 3–4 exercises, with dosage and progression adjusted by phase and pain response.

What pain levels or pain types determine readiness to progress to the next phase?

Progression is guided by quality of motion and pain; none or minimal pain (0–4/10 on the Numerical Rating Scale) is one milestone, and patients should be educated that constant, radiating, or prolonged pain after exercises is unacceptable.

Sep 17, 2026

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