{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:50:36Z","timestamp":1790833836686,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","license":[{"start":{"date-parts":[[2024,1,17]],"date-time":"2024-01-17T00:00:00Z","timestamp":1705449600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                    <jats:sec>\n                        <jats:title>Objective<\/jats:title>\n                        <jats:p>To assess the effects of an additional programme of physiotherapy in\n                            adults with a first-time traumatic shoulder dislocation compared with\n                            single session of advice, supporting materials, and option to self-refer\n                            to physiotherapy.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Design<\/jats:title>\n                        <jats:p>Pragmatic, multicentre, randomised controlled trial\n                            (ARTISAN).<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Setting and participants<\/jats:title>\n                        <jats:p>Trauma research teams at 41 UK NHS Trust sites screened adults with\n                            a first time traumatic anterior shoulder dislocation confirmed\n                            radiologically, being managed non-operatively. People were excluded if\n                            they presented with both shoulders dislocated, had a neurovascular\n                            complication, or were considered for surgical management.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Interventions<\/jats:title>\n                        <jats:p>One session of advice, supporting materials, and option to\n                            self-refer to physiotherapy (n=240) was assessed against the same advice\n                            and supporting materials and an additional programme of physiotherapy\n                            (n=242). Analyses were on an intention-to-treat basis with secondary per\n                            protocol analyses.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Main outcome measures<\/jats:title>\n                        <jats:p>The primary outcome was the Oxford shoulder instability score (a\n                            single composite measure of shoulder function), measured six months\n                            after treatment allocation. Secondary outcomes included the QuickDASH,\n                            EQ-5D-5L, and complications.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>482 participants were recruited from 40 sites in the UK. 354 (73%)\n                            participants completed the primary outcome score (n=180 allocated to\n                            advice only, n=174 allocated to advice and physiotherapy). Participants\n                            were mostly male (66%), with a mean age of 45 years. No significant\n                            difference was noted between advice compared with advice and a programme\n                            of physiotherapy at six months for the primary intention-to-treat\n                            adjusted analysis (between group difference favouring physiotherapy 1.5\n                            (95% confidence interval \u22120.3 to 3.5)) or at earlier three month and six\n                            week timepoints. Complication profiles were similar across the two\n                            groups (P&gt;0.05).<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Conclusions<\/jats:title>\n                        <jats:p>An additional programme of current physiotherapy is not superior to\n                            advice, supporting materials, and the option to self-refer to\n                            physiotherapy.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec>\n                        <jats:title>Trial registration<\/jats:title>\n                        <jats:p>Current Controlled Trials<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"isrctn63184243\" ext-link-type=\"isrctn\">isrctn63184243<\/jats:ext-link>.<\/jats:p>\n                    <\/jats:sec>","DOI":"10.1136\/bmj-2023-076925","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T15:36:23Z","timestamp":1706196983000},"page":"e076925","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Acute rehabilitation following traumatic anterior shoulder dislocation\n                        (ARTISAN): pragmatic, multicentre, randomised controlled trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"isrctn63184243","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn63184243","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn63184243","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8010-164X","authenticated-orcid":false,"given":"Rebecca S","family":"Kearney","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2992-048X","authenticated-orcid":false,"given":"David R","family":"Ellard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2765-3728","authenticated-orcid":false,"given":"Helen","family":"Parsons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3589-6751","authenticated-orcid":false,"given":"Aminul","family":"Haque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-4082","authenticated-orcid":false,"given":"James","family":"Mason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7401-1923","authenticated-orcid":false,"given":"Henry","family":"Nwankwo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1663-4462","authenticated-orcid":false,"given":"Helen","family":"Bradley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9523-682X","authenticated-orcid":false,"given":"Stephen","family":"Drew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3337-4419","authenticated-orcid":false,"given":"Chetan","family":"Modi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9360-0504","authenticated-orcid":false,"given":"Howard","family":"Bush","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1667-4275","authenticated-orcid":false,"given":"David","family":"Torgerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-1708","authenticated-orcid":false,"given":"Martin","family":"Underwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,1,17]]},"reference":[{"key":"2024012507142728000_384.jan17_8.e076925.1","doi-asserted-by":"publisher","DOI":"10.3310\/hta23010"},{"key":"2024012507142728000_384.jan17_8.e076925.2","doi-asserted-by":"publisher","DOI":"10.1177\/1758573215585656"},{"key":"2024012507142728000_384.jan17_8.e076925.3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD004962.pub3"},{"key":"2024012507142728000_384.jan17_8.e076925.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-015-2156-3"},{"key":"2024012507142728000_384.jan17_8.e076925.5","unstructured":"National 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