One session of advice just as effective as rehab for many older patients
A new Danish study shows that extended rehabilitation programmes don't necessarily lead to better outcomes than a single advisory session.
Three questions for Behnam Liaghat about the study
What does the study investigate?
Whether older adults with shoulder fractures achieve better outcomes from a rehabilitation programme
or from a single session of advice and guidance.
What is the key finding?
There was no difference in pain, function or quality of life after either six or twelve months.
How can the results be used?
The findings suggest that patients can recover well without long rehabilitation – and that healthcare resources
can be used more effectively.
- We found no clear differences in pain, shoulder function or quality of life after either 6 or 12 months between those who received rehabilitation and those who didn’t, says Behnam Liaghat, associate professor at the University of Southern Denmark.
He conducts research into shoulder and knee rehabilitation as well as sports injuries at the Department of Sports Science and Biomechanics and is the lead author of the study.
- This is an important finding because it could lead to a more targeted use of healthcare resources and aligns with the "Choosing Wisely" approach, which aims to reduce unnecessary treatments or procedures in the Danish healthcare system.
Choosing Wisely
Choosing Wisely is a collaboration between the Danish Organisation of Medical Societies and Danish Patients, representing 125 medical societies and 105 patient and family organisations.
The initiative identifies areas of the healthcare system where unnecessary tests, treatments or procedures are carried out - and recommends that they be discontinued.
The first trial to make a direct comparison
Previous studies have mainly focused on less severe fractures or on different types of exercise. This is the first trial to directly compare an extended rehabilitation programme with a single advisory session among older adults with more complex fractures.
The study also included patients with more displaced fractures than in earlier research, which strengthens the relevance of the findings for clinical practice.
In total, 60 people aged over 60 took part in the trial. All participants received an initial consultation with advice on managing pain and resuming everyday activities. Half of them were then offered a standard rehabilitation programme in their local municipality, while the others received no further training. After both 6 and 12 months, there were no measurable differences in how their shoulders were functioning.
Tailoring treatment rather than standard programmes
Behnam Liaghat emphasises that some patients may still benefit from rehabilitation – but that it should not be an automatic solution.
– Many older adults with this type of shoulder fracture can recover well with a small number of clear, targeted recommendations. We need to become better at tailoring treatment to the individual rather than offering the same approach to everyone, he says.
Facts about shoulder fractures in older adults
What is a fracture?
A fracture means a bone has broken. It may be a small crack or a complete break where the pieces are separated.
What is a displacement?
Displacement means that the broken pieces of bone have moved from their normal position.
What is a displaced shoulder fracture?
In a shoulder fracture (proximal humerus fracture) near the shoulder joint, the break may be with or without displacement.
In Denmark, displaced shoulder fractures in older adults are often treated without surgery.
How common are shoulder fractures?
Fractures of the upper arm near the shoulder are the third most common bone fracture in older adults — after hip and forearm fractures.
In Denmark, around 5,000 people are affected each year, most of them over 65. The risk increases with age and is closely linked to osteoporosis.
More treatment isn't always better
The results suggest that it’s not always necessary to refer patients for extended rehabilitation after a shoulder fracture. Many patients can recover just as well with a few simple pieces of advice, which can save both time and effort for the individual.
– Many of the older patients we spoke to were mainly concerned with being able to manage on their own and return to their daily activities. That doesn’t necessarily require weeks of exercises with a physiotherapist, says Behnam Liaghat.
About the study:
Method:
The trial involved 60 patients over the age of 60 with displaced shoulder fractures treated without surgery.
All received a single advisory consultation, and half were then selected for a municipal rehabilitation programme.
Shoulder function, pain and quality of life were assessed at six and twelve months.
The study was conducted at Zealand University Hospital in close collaboration with Professor and orthopaedic surgeon Stig Brorson.
Funding:
The study was funded by the Region Zealand Health Science Research Foundation and the Oak Foundation.
Neither funding body influenced the data or analysis.
Read more:
The study is published in the Journal of Shoulder and Elbow Surgery and can be found here:
https://www.jshoulderelbow.org/article/S1058-2746(25)00855-9/fulltext
Meet the researcher
Behnam Liaghat is an associate professor at the Department of Sports Science and Biomechanics. He is a specialist in sports physiotherapy and conducts research into rehabilitation of the shoulder and knee, as well as sports injuries.