2015 ISAKOS Biennial Congress ePoster #2421

Factors Related to Improved Quality of Life for Patients Treated for Rotator Cuff Tears

Joel Gagnier, ND, MSc, PhD, Ann Arbor, MI UNITED STATES
Christopher Robbins, PhD, Ann Arbor, MI UNITED STATES
Asheesh Bedi, MD, Ann Arbor, MI UNITED STATES
James Carpenter, Ann Arbor, MI UNITED STATES
Bruce S. Miller, MD, MS, Ann Arbor, MI UNITED STATES

University of Michigan, Ann Arbor, MI, USA

FDA Status Not Applicable

Summary: These initial findings provide information regarding fixed factors related to successful quality of life outcomes for rotator cuff tear patients.

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Abstract:

Introduction

Rotator cuff disease is common and it is accepted that an age-related prevalence of full-thickness tears exists with over 30% of individuals over the age of sixty having a RCT. Despite this high prevalence, the support for surgical versus non-surgical management of symptomatic rotator cuff disease is limited. It is the intent of this research to examine factors that influence quality of life (QOL) outcomes for those with full thickness RCT’s based on surgical versus non-surgical intervention.

Methods

A convenience sample of participants (N=212) presenting to an orthopaedic clinic and having full thickness RCT’s were invited to participate in a prospective cohort study. Participants provided baseline demographics and completed patient satisfaction, pain VAS, shoulder activity level, functional comorbity, WORC and ASES instruments, and the Veterans Rand 12-item health survey (VR-12). Participants were tracked for operative vs. non-operative intervention and completed the same measures as baseline at 4, 8, 16, 32, 48, and 64 weeks. Statistical analysis was conducted using SPSS v. 21.0.

Results

Participant demographics consisted of 126 males and 86 females with a mean age of 60 years old (SD=9.6). There were 93 participants in the non-operative group and 119 in the operative group. Among baseline scores, there were differences in pain VAS (p<.05), shoulder activity level (p<.01), functional comorbidity (p<.05), ASES (p<.05), and WORC (p<.05), with all baseline scores indicating “worse” scores for the operative group. There were no significant differences between groups for baseline PCS (p=.508) and MCS (p=.862) QOL scores.
Paired samples t-tests within the non-operative group indicate no difference between baseline and 64 week PCS and MCS scores. The operative group PCS and MCS scores were both significantly different from baseline to 64 week scores (all p<.001). Factors predictive of higher MCS scores were non-diabetic (ß=4.82, p<.05), non-smoker (ß=4.52, p<.05), lower functional comorbidity (ß= -1.22, p<.05), higher baseline pain VAS (ß=.087, p<.05), and lower WORC score (ß= -.011, p<.001). Factors predictive of higher PCS scores were surgical intervention (ß=2.96, p<.01), non-diabetic (ß=2.87, p<.05), lower functional comorbidity (ß= -1.18, p<.001), higher baseline ASES (ß=.128, p<.01), and lower baseline WORC (ß= -.005, p<.01).

Discussion

In this patient population, intervention had no effect on MCS scores but there was evidence to support the efficacy of operative treatment for improving PCS scores over time. The two groups were fairly homogenous regarding variables such as tear size, side of injury, and symptom duration however the operative group had more males, younger age, more injuries with a known cause, and worse baseline scores. Of these patients that elected operative intervention their long-term QOL outcomes were much improved.

Significance

To the best of our knowledge this is the first prospective pragmatic trial to focus on both surgical and non-surgical management of rotator cuff tears. These initial findings provide some additional information regarding fixed factors related to successful QOL outcomes for RCT patients.