***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Purpose The purpose of this study was the evaluation of the effectiveness of supervised rehabilitation in comparison to uncontrolled exercise therapy after surgical reconstruction of rotator cuff interrupted tendons . Methods Twenty two patients with comparable level of disability after the same type of surgery were r and omly divided into two equal groups . The first group took part in a supervised therapy and the second one performed simple exercises without supervision .  Clinical and neurophysiological examinations were performed prior to rehabilitation and after 20 and 40 days of treatment . The evaluation included the assessment of the pain level with visual analog scale , active range of motion with goniometer , activity of muscle 's motor units at rest and during maximal effort with electromyography and transmission of motor fibers in brachial plexus with electroneurography ( M-wave stimulation studies ) . Results In the group of supervised patients the active range of movement changed significantly from 26.4 ° to 101.5 ° on average for flexion with adduction while flexion with abduction improved from 21 ° to 95.5 ° . Pain sensation changed from 6.4 to 3.2 . The mean resting electromyogram amplitude decreased to the greatest degree from 80.9μV to 36.8μV in trapezius muscle while maximal effort electromyogram amplitude increased in this muscle from 381.8μV to 790.9μV. The mean values of amplitudes in electroneurographical suprascapular nerve examinations increased from 536.4μV to 1691μV. No significant differences at P=0.05 were found in these parameters recorded in the patients performing uncontrolled exercises . Conclusion The supervised exercise therapy is more effective than uncontrolled one after the rotator cuff surgical reconstruction Purpose The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair . Methods Thirty-one patients who underwent rotator cuff repair prospect ively completed the Pittsburgh Sleep Quality Index  , the Western Ontario Rotator Cuff Index  , and the Constant and Murley shoulder scores  before surgery and at 6 months after surgery . Preoperative demographic , clinical , and radiologic parameters were also evaluated . Results The study analysed 31 patients with a median age of 61 years . There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions ( p < 0.001 ) . A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores ( p ˂ 0.001 ) . ConclusionS leep disorders are commonly seen in patients with rotator cuff tear , and after repair , there is an increase in the quality of sleep with a parallel improvement in shoulder functions . However , no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality . It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life . Level of evidence IV Background : Little is known about the influence of rotator cuff pathology on sleep . The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease . Methods : A nonr and omized , cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality . Data collected at time zero ( before any treatment ) included the  Single Assessment Numeric Evaluation rating  , the  American Shoulder  and Elbow  Surgeons score , the  Pittsburgh Sleep Quality Index  , patient demographics , and medical comorbidities . Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance . Results : Nocturnal pain was reported by 91 % of the 391 participants ( 274 with tendinitis and 117 with rotator cuff tears ) . Participants had a mean age of 57 years . Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores ( 0.27 and 0.31 ; P = 0.004 and P < 0.0001 , respectively ) , depression ( 0.27 and 0.30 ; P < 0.01 ) , female sex ( 0.24 and 0.27 ; P < 0.001 ) , presence of low back pain ( 0.25 and 0.27 ; P < 0.01 ) , diabetes mellitus ( 0.24 in the rotator cuff tear group ; P < 0.01 ) , and increased body mass index ( 0.22 and 0.27 ; P = 0.02 ) . Discussion : The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index . These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity . Conclusion : Worse sleep quality scores in patients with rotator cuff disease are associated with pain , depression , female sex , low back pain , diabetes mellitus , and high body mass index . Overall , sleep quality did not differ among patients with varying rotator cuff disease severity . Only hypertension ( in patients with rotator cuff tears ) and concurrent cervical pathology ( in patients with tendinitis ) were uniquely related to the disease classification . Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease . Level of Evidence : Level III prognostic cohort STUDY DESIGN A prospect i ve unblinded r and omized clinical trial . OBJECTIVES To compare the effectiveness of 2 types of home program instruction , videotape versus personal instruction by a physical therapist , on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear . BACKGROUND Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs . Therefore , assessing the effectiveness of different methods of home program instruction is important . METHODS AND MEASURES Patients who consented to undergo surgical repair were r and omly assigned to either a videotape or personal instruction group . A self-reported compliance log categorized subjects as fully compliant , partially compliant , or noncompliant . The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12 , 24 , and 52 weeks postoperatively . The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time , were assessed by 2 separate 2x3x4 multiple analyses of variances ( MANOVAs ) , 1 for each outcome measure ( alpha = 0.025 ) . RESULTS Neither MANOVA was significant and the null hypotheses were not rejected . The main effect of time ( number of weeks postsurgery ) was significant across all time intervals for both outcome measures ( P < 0.0005 ) . CONCLUSIONS With a therapist available for questions , patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist . Self-reported compliance with the rehabilitation program had little effect on the outcomes BACKGROUND The optimal treatment for symptomatic , nontraumatic rotator cuff tear is unknown . The purpose of this trial was to compare the effectiveness of physiotherapy , acromioplasty , and rotator cuff repair for this condition . We hypothesized that rotator cuff repair yields superior results compared with other treatment modalities . METHODS One hundred and eighty shoulders with symptomatic , nontraumatic , supraspinatus tears were r and omized into one of three cumulatively design ed intervention groups : the physiotherapy-only group ( denoted as Group 1 ) , the acromioplasty and physiotherapy group ( denoted as Group 2 ) , and the rotator cuff repair , acromioplasty , and physiotherapy group ( denoted as Group 3 ) . The Constant score was the primary outcome measure . Secondary outcome measures were visual analog scale for pain , patient satisfaction , rotator cuff integrity in a control imaging investigation , and cost of treatment . RESULTS One hundred and sixty-seven shoulders ( 160 patients ) were available for analysis at two years . There were no significant differences ( p = 0.38 ) in the mean change of Constant score : 18.4 points ( 95 % confidence interval , 14.2 to 22.6 points ) in Group 1 , 20.5 points ( 95 % confidence interval , 16.4 to 24.6 points ) in Group 2 , and 22.6 points ( 95 % confidence interval , 18.4 to 26.8 points ) in Group 3 . There were no significant differences in visual analog scale for pain scores ( p = 0.45 ) and patient satisfaction ( p = 0.28 ) between the groups . At two years , the mean sagittal size of the tendon tear was significantly smaller ( p < 0.01 ) in Group 3 ( 4.2 mm ) compared with Groups 1 and 2 ( 11.0 mm ) . Rotator cuff repair and acromioplasty were significantly more expensive than physiotherapy only ( p < 0.01 ) . CONCLUSIONS There was no significant difference in clinical outcome between the three interventions at the two-year follow-up . The potential progression of the rotator cuff tear , especially in the non-repaired treatment groups , warrants further follow-up . On the basis of our findings , conservative treatment is a reasonable option for the primary initial treatment for isolated , symptomatic , nontraumatic , supraspinatus tears in older patients . LEVEL OF EVIDENCE Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence Background The surgical repair of shoulder pathologies , including rotator cuff disease and acromio-clavicular joint arthritis , have undergone many technical advances . However the debilitating postoperative stiff shoulder remains a common and significant complication of these surgeries , occurring in 4.9 to 23.2 % of patients undergoing rotator cuff repairs . The pathology of the pathological postoperative stiff shoulder and its associated condition “ frozen shoulder ” are poorly understood and both lack formal objective clinical diagnostic criteria . Additionally , although factors associated with the development of idiopathic frozen shoulder have been well described , multiple studies looking at predictors of postoperative stiff shoulder have produced conflicting results . It has been hypothesised that increased pain in the postoperative period , and depression may be predictors of the development of postoperative stiff shoulder . Method A prospect i ve cohort study involving 132 consecutive participants . Preoperatively , participants undergoing arthroscopic subacromial decompression and /or excision of the distal clavicle and /or rotator cuff repair  will complete question naires about their levels of  shoulder pain using a numerical rating scale from 0 to 10 , and answer a Patient Health Question naire – 9 depression question naire . Postoperatively , the participants ’ pain levels will be self-assessed at two , five and seven days and weeks four , seven and ten . They will complete the depression question naire twice , at the time of their routine first and final postoperative appointments with the treating surgeon . At the final appointment , approximately three months postoperatively , the treating surgeon will clinical ly diagnose participants as having a postoperative stiff shoulder or not . Their shoulders ’ range of motion will be measured . The incidence of postoperative stiff shoulder will be determined , both pain and depression will be analysed as predictors for its development and incidences determined by different objective criteria will be compared . Discussion This trial will add to clinical underst and ing of the postoperative stiff shoulder by providing further insight into the incidence of this condition following shoulder surgery and assessing whether perioperative pain and depression can be used as clinical predictors of postoperative stiff shoulder or markers for possible early intervention . This study will also allow the comparison of incidences determined by different objective criteria in the same cohort . Trial registration Australian New Zeal and Clinical Trials Registry (ANZCTR).ACTRN12613001271796.17 - 11 - 2013 The optimal form of rehabilitation after rotator cuff repair has yet to be determined . A r and omised clinical trial was undertaken to compare outcomes for two forms of rehabilitation for this condition : individualised supervised physiotherapy treatment , and a st and ardised unsupervised home exercise regime .  Fifty-eight volunteers with all sizes of operatively repaired rotator cuff tears were allocated r and omly to one of the two treatment groups . All subjects received a st and ardised home exercise regime . Subjects who were r and omised to the physiotherapy group received additional individualised treatment . Independent , blinded assessment s of range of motion , muscle force and functional outcome measures were performed pre-operatively , and at six , 12 and 24 weeks postoperation . At six , 12 and 24 weeks post-operation , comparable outcomes were demonstrated for both rehabilitation groups . By 24 weeks post-operation , most subjects demonstrated outcomes that were consistent with a favourable recovery , regardless of rehabilitation mode . On the basis of these results , outcomes for subjects allocated to individualised physiotherapy treatment after rotator cuff repair are no better than for subjects allocated to a st and ardised home exercise regime Background In many areas of orthopaedics , patients with greater levels of psychological distress report inferior self- assessment s of pain and function . This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales , even those not traditionally considered to have a psychological component . Questions / purpose sThis study attempts to answer the following questions : ( 1 ) Are higher levels of psychological distress associated with clinical ly important differences in baseline scores on the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair ? ( 2 ) Does psychological distress remain 
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Moreover , higher costs were described for supervised rehabilitation .
Conclusions : although several publications address the problem of RC lacerations , there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocol s. This systematic review and meta- analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores , while outlining the pros and cons of each protocol