Article

Minimal research has examined the prognostic ability of shoulder
examination data or psychosocial factors in predicting patient-reported
disability following surgery for rotator cuff pathology.
The purpose of this
study was to examine these factors for prognostic value in order to help
clinicians and patients understand preoperative factors that impact disability
following surgery. METHODS: Sixty-two patients scheduled for subacromial
decompression with or without supraspinatus repair were recruited. Six-month
follow-up data were available for 46 patients. Patient characteristics, history
of the condition, shoulder impairments, psychosocial factors, and
patient-reported disability questionnaires were collected preoperatively. Six
months following surgery, the Western Ontario Rotator Cuff Index (WORC) and
global rating of change dichotomized subjects into responders versus
nonresponders. Logistic regression quantified prognostic ability and created the
most parsimonious model to predict outcome. RESULTS: Being on modified job duty
(OR = .17, 95%CI: 0.03-0.94), and having a worker's compensation claim (OR =
0.08, 95%CI: 0.01-0.74) decreased probability of a positive outcome, while
surgery on the dominant shoulder (OR = 11.96, 95%CI: 2.91-49.18) increased
probability. From the examination, only impaired internal rotation strength was a
significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ)
score (OR = 0.95, 95%CI: 0.91-0.98) and the FABQ_work subscale (OR = 0.92, 95%CI:
0.87-0.97) were univariate predictors. In the final model, surgery on the
dominant shoulder (OR = 8.9, 95%CI 1.75-45.7) and FABQ_work subscale score </=25
(OR = 15.3, 95%CI 2.3-101.9) remained significant. DISCUSSION: Surgery on the
dominant arm resulted in greater improvement in patient-reported disability,
thereby increasing the odds of a successful surgery. The predictive ability of
the FABQ_work subscale highlights the potential impact of psychosocial factors on
patient-reported disability. Implications for Rehabilitation Impairment-based
shoulder measurements were not strong predictors of patient-reported outcome.
Having high fear-avoidance behavior scores on the FABQ, especially the work
subscale, resulted in a much lower chance of responding well to rotator cuff
surgery as measured by self-reported disability. Having surgery on the dominant
shoulder, as compared to the nondominant side, resulted in larger improvements in
disability levels.

Langue : ANGLAIS