Structured rehabilitative aftercare significantly improves shoulder function and socio-environmental engagement following top surgery

Background Top surgery is an important procedure for Two Spirit, trans, gender diverse, and non-binary (2S/TGDNB) individuals however, standardized aftercare recommendations and consistent timelines for rehabilitation are lacking. The purpose of our study was to measure patient-reported upper limb function, socio-environmental engagement, pain interference, and pain severity in individuals receiving top surgery, over an 11-week rehabilitation program.Methods Forty-two 2S/TGDNB individuals participated. Individualized rehabilitative aftercare started 10-days postoperatively, and included one treatment per week, for 11 weeks. Upper limb function was measured using the Disabilities of the Arm, Shoulder, and Hand scale. Socio-environmental engagement was assessed using a subsection of the Body Dysmorphic Disorder Symptom Scale while pain interference and pain severity were evaluated with the Brief Pain Inventory. Questionnaires were completed prior to surgery, then again at weeks 1, 5, and 11 postoperatively. Separate repeated-measures analyses of variance were used to identify differences in all measures across the 4 time points.Results During an 11-week rehabilitation program, our participants experienced a significant statistical and clinical improvement in upper limb function (p < 0.001; η2= 0.878). Participants self-reported avoiding approximately 3 less socio-environmental experiences which represents a clinically significant improvement in socio-environmental engagement (p < 0.001; η2= 0.331). Lastly, pain interference (p < 0.001; η2 = 0.6) and pain severity (p < 0.001; η2= 0.372) did not negatively impact the rehabilitation.Conclusion Our findings demonstrate that standard postoperative rehabilitation benefited a cohort following top surgery. The timeline for rehabilitative care used in this study can be applied by qualified care providers to support individuals following top surgery.