Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
However , these factors were not associated with patient-reported outcomes after intervention .
Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
Background Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears .
However , to our knowledge , a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population .
Questions / purpose s ( 1 ) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears ? (
2 ) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears ?
One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress
Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self- assessment s of pain and function . In several other areas of orthopaedics , higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery . To our knowledge , the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated . Questions / purpose s(1 ) Are higher levels of preoperative psychological distress associated with differences in outcome scores ( visual analog scale [ VAS ] for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 2 ) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores ( VAS for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 3 ) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled ; 70 patients ( 82 % ) were assessed at 1-year followup . During the study period , the three participating surgeons performed 269  rotator cuff repairs ; in large part , the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study . Psychological distress was quantified using the Distress Risk Assessment Method question naire , and patients completed self- assessment s including the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair . Fifty of 85 patients ( 59 % ) had normal levels of distress , 26 of 85 ( 31 % ) had moderate levels of distress , and nine of 85 ( 11 % ) had severe levels of distress . Statistical models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function at 1 year after surgery . Results With the numbers available , distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain ( 1.9 [ 95 % confidence interval { CI } , 1.0–2.8 ] versus 1.0 [ 95 % CI , 0.5–1.4 ] , p = 0.10 ) , Simple Shoulder Test ( 9 [ 95 % CI , 8.1–10.4 ] versus 11 [ 95 % CI , 10.0–11.0 ] , p = 0.06 ) , or American Shoulder and Elbow Surgeons scores ( 80 [ 95 % CI , 72–88 ] versus 88 [ 95 % CI , 84–92 ] , p = 0.08 ) 1 year after arthroscopic rotator cuff repair . With the numbers available , distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain ( 3 [ 95 % CI , 2.2–4.1 ] versus 2 [ 95 % CI , 1.4–2.9 ] , p = 0.10 ) , Simple Shoulder Test ( 5.2 [ 95 % CI , 3.7–6.6 ] versus 5.0 [ 95 % CI , 4.2–5.8 ] , p = 0.86 ) , or American Shoulder and Elbow Surgeons scale ( 38 [ 95 % CI , 29–47 ] versus 30 [ 95 % CI , 25–36 ] , p = 0.16 ) . The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 ( 20 % ) versus 35 of 85 ( 41 % ) preoperatively ( odds ratio , 0.36 ; 95 % CI , 0.17–0.74 ; p = 0.005 ) . Conclusions Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinical ly important degree in this small series of patients with rotator cuff tears . This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status . Level of Evidence Level I , prognostic study
Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
However , these factors were not associated with patient-reported outcomes after intervention .
Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
Background Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears .
However , to our knowledge , a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population .
Questions / purpose s ( 1 ) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears ? (
2 ) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears ?