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Prospective evaluation of postoperative compliance and outcomes after rotator cuff repair in patients with and without workers' compensation claims. JSES
This important study drives home the lesson that important determinants of the outcome of treatment are related to the patient and not to the shoulder (again Osler: it is more important to know what patient the disease has than to know what disease the patient has). In this study the authors found that individuals having Workman's Compensation Claims are less likely to be compliant with the postoperative protocol for shoulder immobilization and physical therapy than patients without such claims. Furthermore, at a minimum of 12 months after surgery the Simple Shoulder Test scores after treatment were higher for the non-WC group (10.7) than for the WC group (6.0). Among the WC group, compliant patients had higher SSTs (7.9) than non compliant patients (4.3).
Ultrasound examination of the cuff one year after surgery showed that 28 of 42 patients (66%) in the Work Comp group had an intact and healed repair compared with 42 of 50 patients (84%) in the non-Work Comp group. 75% of compliant WC patients had intact cuffs in comparison to 59% of the non-compliant WC patients.
We previously asked the question, "Do shoulder patients insured by workers' compensation present with worse self-assessed function and health status?" We found that patients covered by worker's compensation had lower SST scores and lower SF 36 scores than similar non WC patients. Other studies have shown that patients with workers' compensation claims have worse outcomes after rotator cuff repair.
The study reported here suggests that, in this population, a primary determinant of the structural and functional results after cuff repair was patient compliance - a feature found more commonly in non-WC patients.
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