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. 2019 Oct 29;7(10):2325967119878415.
doi: 10.1177/2325967119878415. eCollection 2019 Oct.

Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair

Anirudh K Gowd  1 , Gregory L Cvetanovich  2 , Joseph N Liu  3 , Benedict U Nwachukwu  4 , Brandon C Cabarcas  5 , Brian J Cole  6 , Brian Forsythe  6 , Anthony A Romeo  6 , Nikhil N Verma  6
Affiliations

Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair

Anirudh K Gowd et al. Orthop J Sports Med. .

Abstract

Background: The incidence of rotator cuff repairs has risen dramatically over the past 10 years, most notably in the working-class population. Return to work (RTW) is a valuable outcome measure to set patient expectations before surgery.

Purpose: To establish the rate of RTW after rotator cuff repair with respect to stratified levels of occupational demand (sedentary, light, moderate, and heavy) and to identify clinical factors significantly associated with postoperative RTW.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who received rotator cuff repair between 2014 and 2017 were queried from a prospectively maintained institutional registry. Work status was evaluated from clinical and physical therapy notes, and RTW was stratified based on duty level. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values were calculated for American Shoulder and Elbow Surgeons (ASES) score and subjective Constant score through use of an anchor-based approach. Patient demographic factors, preoperative ASES scores, Constant scores, and health-related quality of life scores, as well as change in postoperative scores exceeding the thresholds for MCID, SCB, and PASS, were analyzed to determine significant associations with RTW without restriction.

Results: In total, 89 patients with documented pre- and postoperative work status underwent surgery. Rates of RTW for sedentary, light, moderate, and heavy duties were 100%, 84.0%, 77.4%, and 63.3%, respectively, within return at less than 7 postoperative months on average. RTW was associated with achieving PASS (P = .004) but not achieving MCID and SCB (P = .429 and .452, respectively). Injury to a patient's dominant side had reduced odds (0.057; 95% CI, 0.004-0.763; P = .030) for RTW at full duty. Tear characteristics and type of insurance were not associated with RTW. Preoperative Veterans RAND Mental Component Score (>53.3; area under the curve, 70.4%) was predictive of returning to work.

Conclusion: A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. Preoperative mental health scores can predict future return to work, which supports the concept that mental health status plays an important role in the outcomes after rotator cuff repair surgery.

Keywords: minimal clinically important difference; patient acceptable symptom state; quality-based care; return to work; rotator cuff repair; substantial clinical benefit.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: G.L.C. has received research support from Arthrex and educational support from Medwest and Smith & Nephew. J.N.L. has received educational support from Smith & Nephew. B.J.C. has received consulting fees from Arthrex, Genzyme, Pacira Pharmaceuticals, Anika Therapeutics, Geistlich Pharma, Vericel, Bioventus, Zimmer, and Smith & Nephew; educational support from Arthrex and Pacira Pharmaceuticals; royalties from Arthrex and DJO; nonconsulting fees from Arthrex, Carticept Medical, and LifeNet Health; and hospitality payments from Aesculap/B.Braun, DePuy, and GE Healthcare. B.F. has received consulting fees from Sonoma Orthopedics and Stryker, honorarium from Arthrosurface, and educational support from Medwest. A.A.R. has received consulting fees and royalties from Arthrex. N.N.V. has received consulting fees from Smith & Nephew and Medacta USA, royalties from Smith & Nephew, nonconsulting fees from Pacira Pharmaceuticals, educational support from Medwest, and hospitality payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Change in outcome measure before and after surgery. ASES, American Shoulder and Elbow Surgeons; SANE, Single Assessment Numeric Evaluation; VRMCS, Veterans RAND Mental Component Score; VRPCS, Veterans RAND Physical Component Score; VR-6D, Veterans RAND 6-Dimensions. *VR-6D graphically represented as 10 times the score for scale.
Figure 2.
Figure 2.
Youden index estimate of minimal clinically important difference of the American Shoulder and Elbow Surgeons score in rotator cuff repair. AUC, area under the curve.
See this image and copyright information in PMC

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