These authors studied 169 patients with full-thickness rotator cuff tears using the Short Form-36, visual analog scales for shoulder pain and function, the Simple Shoulder Test (SST), and the American Shoulder and Elbow Surgeons (ASES) instrument at the time of diagnosis. These results were correlated with the MRI interpretation of the number of tendons involved, tear size, tendon retraction, and tear surface area as well as sex, body mass index, number of medical comorbidities, smoking status, and Workers' Compensation status.
The SF-36 mental component summery (MCS) had the strongest correlation with the visual analog scale for shoulder pain, the visual analog scale for shoulder function, the SST, and the ASES score.
Tear severity by MRI only correlated with the visual analog scale for shoulder function. Tear severity did not correlate with other scores in bivariate correlations. In all multivariate models, the SF-36 MCS had the strongest association with the visual analog scale for shoulder pain, the visual analog scale for shoulder function, the SST, and the ASES score.
The authors conclude that patient mental health may play an influential role in patient-reported pain and function in patients with full-thickness rotator cuff tears.
Comment: Once again we see that the symptoms experienced by patients rotator cuff tears are related to factors other than the severity of the rotator cuff pathology. The importance of the different elements of the SF36 on shoulder comfort and function is shown by prior studies as well. Three relevant abstracts are provided here. Again we emphasize the importance of the 4Ps (patient, problem, physician, procedure): the characteristics of the patient may be more important than the characteristics of the shoulder problem. These studies help us realize that patients with poor mental health are likely to have poorer shoulder comfort and function both before and after treatment.
Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease.
Although most patients are improved after shoulder arthroplasty, the degree of improvement is variable. The factors contributing to this variability are not well understood. In particular, little information is available regarding the preoperative characteristics of the patient that may influence the quality of the result. This study correlated patient demographics, preoperative health status, and preoperative shoulder function with 3 outcome metrics: comfort, physical role function, and shoulder-specific function. One hundred thirty-four shoulders having total shoulder arthroplasty for degenerative glenohumeral joint disease had an average follow-up of 3.4 +/- 1.8 years. The SF-36 Comfort score improved from 39 to 61 (P < .0001). The SF-36 Physical Role Function score improved from 30 to 52 (P < .0001). The average number of Simple Shoulder Test functions performable (out of 12) improved from 4 to 9 (P < .0001). The strongest correlates with postoperative comfort included preoperative physical function (P < .0001), general health (P < .0001), and social function (P < .001). The strongest correlates with postoperative physical role function included preoperative physical function (P < .0001) and general health (P < .001). The strongest correlates with postoperative shoulder function included male gender (P < .0001), and preoperative physical function (P < .0001), social function (P < .0001), mental health (P < .0001) and shoulder function (P < .0001). These data indicate that the overall well-being of the patient before surgery is strongly correlated with the quality of the outcome from total shoulder arthroplasty for degenerative glenohumeral joint disease.
A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.
Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.
Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.
As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.
Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.
The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.
We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.
The authors conclude that patient mental health may play an influential role in patient-reported pain and function in patients with full-thickness rotator cuff tears.
Comment: Once again we see that the symptoms experienced by patients rotator cuff tears are related to factors other than the severity of the rotator cuff pathology. The importance of the different elements of the SF36 on shoulder comfort and function is shown by prior studies as well. Three relevant abstracts are provided here. Again we emphasize the importance of the 4Ps (patient, problem, physician, procedure): the characteristics of the patient may be more important than the characteristics of the shoulder problem. These studies help us realize that patients with poor mental health are likely to have poorer shoulder comfort and function both before and after treatment.
Correlates with comfort and function after total shoulder arthroplasty for degenerative joint disease.
Although most patients are improved after shoulder arthroplasty, the degree of improvement is variable. The factors contributing to this variability are not well understood. In particular, little information is available regarding the preoperative characteristics of the patient that may influence the quality of the result. This study correlated patient demographics, preoperative health status, and preoperative shoulder function with 3 outcome metrics: comfort, physical role function, and shoulder-specific function. One hundred thirty-four shoulders having total shoulder arthroplasty for degenerative glenohumeral joint disease had an average follow-up of 3.4 +/- 1.8 years. The SF-36 Comfort score improved from 39 to 61 (P < .0001). The SF-36 Physical Role Function score improved from 30 to 52 (P < .0001). The average number of Simple Shoulder Test functions performable (out of 12) improved from 4 to 9 (P < .0001). The strongest correlates with postoperative comfort included preoperative physical function (P < .0001), general health (P < .0001), and social function (P < .001). The strongest correlates with postoperative physical role function included preoperative physical function (P < .0001) and general health (P < .001). The strongest correlates with postoperative shoulder function included male gender (P < .0001), and preoperative physical function (P < .0001), social function (P < .0001), mental health (P < .0001) and shoulder function (P < .0001). These data indicate that the overall well-being of the patient before surgery is strongly correlated with the quality of the outcome from total shoulder arthroplasty for degenerative glenohumeral joint disease.
A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.
Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.
Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.
As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.
Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.
The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.
We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.
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