Monday, February 20, 2017

Is resilience a predictor of the outcomes of total shoulder arthroplasty?

Resilience correlates with outcomes after total shoulder arthroplasty

The Brief Resilience Scale (BRS) is a six item questionnaire that essentially ask in six different phraseologies "do you bounce back easily from disappointment?" 

For 70 patients having primary total shoulders, these authors examined the correlation between resilience, as measured by the BRS, and the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn scores in patients undergoing total shoulder arthroplasty (TSA) at minimum of 2 years (mean, 30 ± 3 months) after surgery. 

Patients were stratified into low-resilience (LR), normal-resilience (NR), and high-resilience (HR) patients.

Postoperative BRS scores significantly correlated with ASES, Penn, and SANE scores (r = 0.41-0.44, P < .004 for all scores). When we evaluated patients based on resilience group, the LR group had a Penn score that was 34 points lower than that in the HR group. Likewise, the LR group had a SANE score that averaged 40 points lower than that in the HR group (SANE score of 53 points in LR group and 92 points in HR group, P = .05). When we evaluated ASES subscores, it appeared that the pain subscale was responsible for most of the difference between the LR and HR groups (29 points and 48 points [out of 50 points], respectively; P = .03).

Comment: These authors concluded that "Resilience is a major predictor of postoperative outcomes after TSA." 

They correlated a number of variables (sex (19 male and 51 female), surgeon (one of three), brand of TSA, resilience) with outcome scores  ≥2 years after surgery. As they point out in the Discussion, the preoperative scores for each patient (recognized by others as a strong predictor of the improvement after TSA) were not available. It is also of note that the BRS was obtained at followup rather than before surgery, so it cannot be known how it was affected by or predicted the outcome.

It would be of interest to see a multivariate analysis that analyzed the relationship of preoperative BRS, preoperative patient-reported shoulder comfort and function, sex, surgeon, diagnosis, and brand of anatomic TSA to the final patient-reported shoulder comfort and function. Such an analysis would reveal the predictive value of the BRS.