Effect of early physical therapy initiation and adherence on functional outcomes after arthroscopic rotator cuff repair: a prospective observational cohort study

Introduction Rotator cuff repair outcomes are influenced not only by surgical technique but also by postoperative rehabilitation. However, the optimal timing of physical therapy (PT) initiation and the role of adherence remain incompletely understood. This study aimed to evaluate the independent and combined effects of early PT initiation and adherence on functional recovery following arthroscopic rotator cuff repair. Methods In this prospective observational cohort study, 160 patients undergoing arthroscopic rotator cuff repair were categorized into early (≤14 days) and delayed (>14 days) PT initiation groups. Functional outcomes were assessed at 3–6 months using validated measures, including the Disabilities of the Arm, Shoulder and Hand (DASH), Shoulder Pain and Disability Index (SPADI), Functional Independence Measure (FIM), and Visual Analog Scale (VAS). PT adherence was stratified by the number of sessions attended. Multivariate regression analysis was performed to identify independent predictors of functional outcomes. Results Early PT initiation and higher adherence were independently associated with significantly improved functional outcomes, including lower DASH and SPADI scores, reduced pain, and greater range of motion ( p ≤ 0.005). PT adherence emerged as the strongest predictor of DASH scores (β = −0.34, p < 0.001). Patients in the early PT group also demonstrated higher adherence levels and better functional independence. Subgroup analysis revealed that older age and larger tear size were associated with poorer outcomes, with a significant interaction effect. Discussion Early initiation of PT combined with high adherence leads to superior functional recovery following arthroscopic rotator cuff repair. These findings highlight the importance of timely and structured rehabilitation protocols and suggest that patient-specific factors such as age and tear size should be considered when designing postoperative rehabilitation strategies.