The Impact of Psychosocial Factors on the Outcome of Surgical Repair for Rotator Cuff Tears – A Prospective Cohort (IMPROVE Study)
Rotator cuff tears are a common cause of pain and reduced function in the shoulder. The impact of psychosocial factors on patient outcomes following rotator cuff repair (RCR) surgery is unclear. The main goal of this thesis was to determine the association of psychosocial factors and outcomes in patients undergoing RCR surgery. Objectives: (1) To determine if psychosocial factors are associated with post-operative outcomes one-year after RCR surgery. (2) To determine if psychosocial factors are associated with disease severity at baseline. (3) To determine if psychosocial measures improve in patients one-year after RCR surgery. (4) To determine if treating surgeons are able to accurately assess patient’s mental health status at the baseline visit. Methods: A multi-centre, prospective, cohort study was performed where patients with a full-thickness rotator cuff tear were enrolled prior to RCR surgery. Patients completed multiple validated questionnaires to measure psychosocial functioning (symptoms of depression, anxiety, pain catastrophizing, treatment expectations and social support) at the pre-operative visit. Patients were followed for one year after their surgery. The primary outcome was the patient-reported Western Ontario Rotator Cuff Index (WORC) completed at one-year. The secondary outcomes were the Constant Murley Score (Constant) and the EQ-5D-5L. A multivariable regression analysis was performed. Results: 244 patients were enrolled, and 137 patients have completed a one-year follow-up. When controlling for other key variables, a multiple linear regression analysis did not demonstrate an independent association between any of the psychosocial factors and WORC scores at one year. Patients with higher levels of pain catastrophizing prior to surgery presented with worse WORC scores, Constant scores, and EQ-5D-5L health index scores at baseline and worse Constant scores at one-year. The remaining psychosocial factors were not associated with worse WORC scores at baseline. Scores on all of the psychosocial questionnaires improved between baseline and the one-year follow-up visit. The surgeons’ rating of patient’s mental health did not agree with the scores from the questionnaires. Conclusion: In this patient population, we found a low rate of clinically significant psychological symptoms and when controlling for other variables, psychosocial factors did not have a significant impact on outcomes after RCR.
Psychosocial factors, Rotator cuff tears, Surgical outcomes
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