School of Health Professions Student Primary Author of Collaborative Journal Publication

• By Mark Hendricks
• October 27, 2023
• Research

Traumatic anterior shoulder dislocations (ASDs), which are most common in active males, are an extremely expensive injury to treat, and though the related complications also can be significant, there is no consensus as to which type of exercise or treatment is most effective.

In a study published by the British Journal of Sports Medicine (“Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis”), Vaishnavi Chiddarwar, a Ph.D. student in the Rehabilitation Science program at the Texas Tech University Health Sciences Center (TTUHSC) School of Health Professions, and a research team from Adelaide, South Australia, Australia investigated the effectiveness of exercise-based interventions (EBIs) on outcomes following traumatic anterior shoulder dislocation, the risk of recurrence and the ability to return to activity of surgery combined with EBI versus EBI alone.

In addition to Chiddarwar, the study’s primary author, the team included Rutger M.J. de Zoete, Ph.D., and Cameron Dickson from the School of Allied Health Science and Practice at the University of Adelaide Faculty of Health and Medical Sciences, and Timothy Lathlean, Ph.D., from the University of Adelaide Faculty of Health and Medical Sciences Medical School and the South Australian Health and Medical Research Institute Limited.

Anterior shoulder dislocations are associated with complications and risk of recurrent instability, and ASD rehabilitation has focused primarily on postsurgical care. The effectiveness of various EBI techniques when compared to surgery plus EBI was unclear prior to this study.

To make the comparison, Chiddarwar said the team conducted a systematic review and meta-analysis of 60 studies. The mean age of participants in the included studies was approximately 27 years, and 56% of those included were males from athletic and non-athletic settings.

Developing the idea for the study actually began during the earliest days of the COVID-19 pandemic. Because travel restrictions prevented Chiddarwar from being able to meet with her Australian colleagues face-to-face, the team designed the study as a systematic review and meta-analysis.

“The availability of human subjects at the time was next to zero, and because systematic reviews and meta-analysis are considered to be a competent form of obtaining research evidence, we thought it was the best way to continue our collaboration,” Chiddarwar said.

The collaborative analysis showed that individuals who underwent EBI alone were 2.03 times more likely to experience recurrent instability (when the top of the arm bone repeatedly slips out of socket) than individuals who underwent EBI in conjunction with surgery. Individuals who underwent a combination of EBI with surgery appeared 1.81 times more likely to return to activity than those who underwent EBI alone.

In addition, the study found that utilizing stand-alone EBIs without shoulder surgery is effective in improving the shoulder’s internal rotation strength and increasing its passive range of motion postinjury, and the use of multiple modes of EBI demonstrated even greater functional improvements. Chiddarwar said more research is needed to improve the quality of evidence upon which the study’s EBI recommendations were based. 

“EBIs, irrespective of the situation, were obviously effective,” Chiddarwar said. “But when combined with surgery, EBIs were more effective. Surgery takes care of the damaged structure of the joint that is usually caused by this injury, so EBIs in combination with surgery were more effective than exercise alone.”

Being able to participate in, write and publish such research wasn’t always part of Chiddarwar’s plan for entering the heath care field. As a physical therapist who specializes in movement sciences and disorders and sports injuries, she’s been interested in active or sporting populations for a very long time. And though she lightheartedly refers to herself as a failed athlete, she has fond memories of enthusiastically watching cricket with her father in their native India.

“I would always tell him that I want to be a part of this cricket frenzy in some way,” Chiddarwar recalled. “My father is a physician, and he said, ‘Why don’t you help the athletes with their injuries in the future? You could take after me and make a career in health care.’ So this research combines the best of both worlds for me: my passion for health care and my love for watching sports. I also felt like sports injuries are almost inevitable, so I knew I would never be out of work if I got involved with that.”

Because sports injuries can be extremely disabling and make it difficult for a person to return to their pre-injury self, Chiddarwar is a big fan of injury risk mitigation and preventative techniques more than treating the injury after it has occurred. Her current area of research includes gender-specific risk factors for knee injury in women, which is far removed from the shoulder injuries she studied with her Australian collaborators, but it keeps her in touch with her interests in active populations and sports injuries.

Roger James, Ph.D., program director for TTUHSC’s Ph.D. in Rehabilitation Science program, said Chiddarwar’s publication demonstrates the need for researching the relationship between surgery and injury rehabilitation.

“This meta-analysis supports the benefits of surgery combined with rehabilitation exercise over exercise alone,” James said. “More studies like this one linking surgical and rehabilitation interventions are needed to improve patient outcomes.”

As she continues working toward her Ph.D., Chiddarwar is grateful for the experience she gained by following a research project from the planning stages to publication. As an early career researcher, she was the youngest and least experienced member of the collaboration, but it gave her tools and confidence that she will one day soon carry with her into her own laboratory.

“This was a steep learning curve for me, but I'm glad that I've been able to now acquire these skills, which are going to help me in the future, not just with collaborations, but even in my own Ph.D. research,” Chiddarwar said. “A systematic review involves a very structured literature search and review, so I feel like I have the upper hand now because I know how to run searches on multiple engines and how to source papers and the related literature. It has actually made me a better scientist.”