Compliance with Sling-Wearing after Rotator Cuff Repair and Anterior Shoulder Stabilization

Abstract

Background Compliance with postoperative sling immobilization after shoulder surgery has not been previously studied. In the present study, we examined the compliance with sling-wearing in patients who had had either undergone anterior stabilization or rotator cuff repair.Methods Patients who had undergone either an arthroscopic rotator cuff repair or shoulder stabilization anonymously answered a detailed standardized questionnaire regarding sling-wearing. Routine postoperative instructions require patients to wear a sling for 3 weeks after repair of a small or medium-sized rotator cuff tear, 4 weeks after anterior stabilization of the shoulder and 6 weeks after repair of a large or massive rotator cuff tear. All patients were contacted within 6 months of surgery. ResultsOlder patients were more likely to be compliant with postoperative instructions, as were patients who had longer periods of acute pain requiring oral analgesia. There was no difference in compliance between patients who had a small rotator cuff tear and those who had a large rotator cuff tear. Nor was there any difference between open and arthroscopic shoulder stabilization groups. DiscussionIn the present study, despite written instructions regarding sling-wearing, there were differences between patient groups with regard to compliance with sling-wearing instructions.

The Effect of Patients’ Understanding of Sling Necessity and Home Assistance on Sling Wear After Shoulder Surgery

“…Patients >60 years of age were found to wear their slings 57.6 hours more per week than younger patients. Nassiri et al 14 similarly showed that patients older than 45 years reported more sling compliance up to 3 weeks postoperatively. Grubhofer et al 7 placed temperature sensors in 54 slings after rotator cuff repair surgery and did not show any associations between sling wear and any patient characteristics.…”

“…Previous studies have attempted to determine the factors associated with sling adherence but have relied on patient-reported sling wear rather than sling wear as measured by a validated temperature-sensing device. 5,14,17 While Silverio and Cheung 17 used the Medical Adherence Measure survey to assess patient-reported adherence, the authors did not address the question related to the sling’s purpose. Nassiri et al 14 assessed sling adherence in patients undergoing rotator cuff repair or shoulder stabilization surgery by sending questionnaires 6 months after surgery.…”

“…5,14,17 While Silverio and Cheung 17 used the Medical Adherence Measure survey to assess patient-reported adherence, the authors did not address the question related to the sling’s purpose. Nassiri et al 14 assessed sling adherence in patients undergoing rotator cuff repair or shoulder stabilization surgery by sending questionnaires 6 months after surgery. The authors reported that 18% of patients thought they did not receive sufficient information to manage their sling postoperatively, and only 5% of patients understood that wearing their sling after surgery would make it less likely that they would need further surgery.…”

“…However, it is important to identify modifiable risk factors for noncompliance. Multiple studies outside of the orthopaedic field have reported the positive relationship between the quality of patient education and patient compliance, 2,3,19,22,25 and Nassiri et al 14 have suggested that education regarding the intended effects of a sling may improve compliance after shoulder surgery.…”

Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review

“…Early post-operative mobilisation has been studied extensively in the lower limb [33][34] and has been associated with decreased pain scores, and rapid recovery of muscle function [35][36][37][38]. Early research following rotator cuff repair suggests that although there is no additional benefit of early over delayed postoperative mobilisation integrity of repair is maintained [39].The possibility of earlier safe mobilisation has important implications for the wide range of patients with TASD, for example, poor compliance with immobilisation periods [40], working populations and loss of earnings [41], the psychological and impact of not being engaged in leisure and sport [42], and for older patients, the risk of stiffness due to prolonged immobilisation [43].…”