Outcome of Expedited Rotator Cuff Surgery in Injured Workers: Determinants of Successful Recovery

Abstract

Background:Work-related rotator cuff injuries are a common cause of disability and employee time loss.Purpose:To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery.Study Design:Case series; Level of evidence, 4.Methods:Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The impact of surgery was assessed by whether the change in the ASES score exceeded the minimal clinically important difference (MCID) of 17 points. Secondary outcomes were range of motion (ROM), medication consumption, and work status.Results:One hundred forty-six patients (43 women [29%], 103 men [71%]; mean age, 52 years; SD, 8 years) completed the study. Sixty-seven (46%) patients underwent rotator cuff repair. The mean time between the date the patient consented to have surgery and the date of surgery was 82 (SD, 44) days. There was a statistically significant improvement in ASES score and ROM and work status (52 returned to regular duties and 59 to modified duties) (P < .0001). Eighty-four percent (n = 122) of patients exceeded the MCID of 17 points. Individual factors that affected patient overall disability were preoperative ASES, work status prior to surgery, access to care, and autonomy at work. Achieving a minimal clinically meaningful change was influenced by perceived access to care, autonomy and stress at work, and overall satisfaction with the job.Conclusion:Expedited rotator cuff surgery improved disability, ROM, and work status in injured workers. Successful recovery after work-related shoulder injuries may further be facilitated by improving the psychosocial work environment and increasing access to care.

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

“…In another study of injured workers, 146 patients who had an expedited RC surgery (46% had a RC repair) improved in disability, as measured by the American Shoulder and Elbow Surgeons (ASES) score, ROM, and work status. 8 In general, acute traumatic tears in young individuals are reported to have a more successful result when repair is performed more promptly. [39][40][41][42] In our sample, patients in the repair group were older which is not surprising in light of RC tear being more prevalent in older individuals.…”

“…Although the literature shows a consistent pattern of less successful results in injured workers compared to the general population, [4][5][6][7] majority of injured workers do benefit from surgery when it is deemed appropriate by the clinicians involved in the care of these patients. 4,[7][8][9][10] Apart from the severity of pathology, chronicity, age, sex, and mechanism of injury, the length of wait time to surgery is reported to affect recovery. 8,[11][12][13][14][15][16][17][18][19] Considering the linear relationship between wait times to receive surgery and developing chronic disability, [20][21][22][23][24] expediting surgery is expected to help with a more successful return to normal function.…”

“…[25][26][27] However, there is only minimal information on the subject in the literature. 8,19,28 Considering, the enormous implications of RC injury for workers, employers, insurers, and health-care providers, further exploration of the impact of pathology on recovery and readiness to return to work will provide a more evidenced base care for this population.…”

Adherence Tracking With Smart Watches for Shoulder Physiotherapy in Rotator Cuff Pathology: Protocol for a Longitudinal Cohort Study

“…The following potentially significant adherence predictors [ 12 , 105 - 110 ] will be collected for each patient at recruitment: age, sex, body mass index, dominant side involvement, symptom duration, mechanism of injury (traumatic or degenerative), rotator cuff tear thickness and size, type of operative procedures, comorbidity (cumulative illness rating scale [ 111 ]), smoking status, alcohol intake, opioid intake, cannabinoid intake, the baseline level of physical activity, education, marital status, job demands, socioeconomic status (current income), perceived social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory [ 112 ]), patient self-efficacy (2-item Pain Self-Efficacy Questionnaire [ 113 ]), Patient Expectation Questionnaire [ 114 ], and Hospital Anxiety and Depression Scale [ 115 ].…”

Measurement Properties of the Return-to-Work Self-Efficacy Scale in Workers with Shoulder Injuries

“…To calculate the coefficient of internal consistency of a scale with three to five points, a sample size of 50 is considered sufficient. 23 For the correlation component, we estimated the sample size on the basis of a correlation coefficient of 0.40 between the RTWSE and the DASH. 24 Thus, to have 50 patients with complete data, we recruited 60 patients to account for potential drop-outs and missing data.…”