Mental toughness - how does it relate to longer term ream and run and total shoulder arthroplasty outcomes?

Shoulder arthroplasty provides a great opportunity for patients with arthritis to recover lost shoulder comfort and function. However, recovery from the operation may challenge the patients' mental as well as their physical toughness. There is evidence that resilience may be an important attribute in the recovery from shoulder surgery.

Several scales have been validated for assessing a person's resilience, including the Brief Resilence Scale

and the The Connor-Davidson Resilience Scale, which assesses the ability to adapt to change, to deal with whatever comes, to see the humorous side of things, to cope with stress, to bounce back after illness or hardship, to achieve goals despite obstacles, to stay focused under pressure, to avoid being discouraged by failure, to think of oneself as being a strong person, and to handle unpleasant feelings.

The authors of Anatomic Shoulder Arthroplasty: The Correlation between Patient Resilience, Mental Health, and Outcome studied 399 patients (195 ream and run (RnR) and 204 anatomic total shoulder (aTSA)) at a mean follow-up of 6.3 ± 3.3 years. 

In this study of anatomic arthroplasties, increased resilience and better mental health were correlated with better outcomes.

In univariable analysis, the Connor Davidson Resilience Scale-10 (CD RISC-10) at latest follow-up was positively correlated with postoperative Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES) and satisfaction after both RnR and aTSA. Mean CD RISC-10 scores were higher in the RnR cohort (34.3 ± 4.8 vs. 32.5 ± 6.2 for aTSA, p<0.001). 

In the multivariable linear regression analysis, greater resilience was associated with better outcomes after anatomic total shoulder arthroplasty: CD RISC-10 was independently associated with postoperative SST, ASES and satisfaction scores in aTSA patients. 

Better mental health was associated with superior outcomes after the ream and run procedure: CD RISC-10 was correlated with satisfaction.Veteran’s RAND-12 Mental Component Score (VR-12 MCS) was correlated with ASES and satisfaction after RnR.

Comment: It may be useful for surgeons to get a sense of the patient's mental toughness before proceeding with surgery and to be sure that appropriate support is in place for those whose resilience may be challenged during post-arthroplasty recovery. 

see also

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

Resiliency Influences Post-Operative Outcomes Following Rotator Cuff Repair

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).