Monday, March 17, 2014

Preoperative confidence predicts the outcome of shoulder arthroplasty - attitude is everything

Patient Pre-operative Confidence in Outcome Predicts Functionality after Total Shoulder Arthroplasty

These authors suggest that a patient’s pre-operative mental state may play an important role in the patient’s functional outcome after surgery. They sought to determine if a patient’s confidence in their ability to return to the level of activity desired after total shoulder arthroplasty would influence their post-operative functional scores.

Patients undergoing a primary total shoulder were required to complete a pre-operative questionnaire that included their demographics, body mass index, Penn Shoulder Score, SF-12 and their confidence in reaching their level of desired functionality post-operatively (scored 0-10). 

Patients then completed an identical post-operative questionnaire at their follow-up visits. 

Of 499 patients eligible, questionnaires were completed by 347 patients at an average follow up of 550 days. Cohort population average age was 66.4 years, females comprised 41.5% and the average BMI was 30.3. Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (standard deviation = 2.2, range 0-10). For every one point increase in confidence, patients experienced an average increase in their function score of 2.9 (95% confidence interval: 1.1, 4.7; p=0.001) and improvement in their pain score of 1.4 (95% CI: 0.2, 2.5; p=0.021) according to the Penn Shoulder Score. 

Comment: The patient’s pre-operative confidence in their ability to attain their desired post-operative functional outcomes is a significant predictor of the patient’s outcome. Patients with greater pre-operative confidence actually have better post-operative functional outcomes than their less confident peers. Surgeons should be reluctant to offer surgery to individuals who lack confidence in a positive outcome.


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