Preoperative Mental Health Scores and Achieving Patient Acceptable Symptom State Are Predictive of Return to Work After Arthroscopic Rotator Cuff Repair

Abstract

Background:The incidence of rotator cuff repairs has risen dramatically over the past 10 years, most notably in the working-class population. Return to work (RTW) is a valuable outcome measure to set patient expectations before surgery.Purpose:To establish the rate of RTW after rotator cuff repair with respect to stratified levels of occupational demand (sedentary, light, moderate, and heavy) and to identify clinical factors significantly associated with postoperative RTW.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who received rotator cuff repair between 2014 and 2017 were queried from a prospectively maintained institutional registry. Work status was evaluated from clinical and physical therapy notes, and RTW was stratified based on duty level. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) values were calculated for American Shoulder and Elbow Surgeons (ASES) score and subjective Constant score through use of an anchor-based approach. Patient demographic factors, preoperative ASES scores, Constant scores, and health-related quality of life scores, as well as change in postoperative scores exceeding the thresholds for MCID, SCB, and PASS, were analyzed to determine significant associations with RTW without restriction.Results:In total, 89 patients with documented pre- and postoperative work status underwent surgery. Rates of RTW for sedentary, light, moderate, and heavy duties were 100%, 84.0%, 77.4%, and 63.3%, respectively, within return at less than 7 postoperative months on average. RTW was associated with achieving PASS (P = .004) but not achieving MCID and SCB (P = .429 and .452, respectively). Injury to a patient’s dominant side had reduced odds (0.057; 95% CI, 0.004-0.763; P = .030) for RTW at full duty. Tear characteristics and type of insurance were not associated with RTW. Preoperative Veterans RAND Mental Component Score (>53.3; area under the curve, 70.4%) was predictive of returning to work.Conclusion:A vast majority of patients undergoing rotator cuff repair can expect to return to work within 8 months of surgery. Preoperative mental health scores can predict future return to work, which supports the concept that mental health status plays an important role in the outcomes after rotator cuff repair surgery.

Return to Work After Primary Rotator Cuff Repair: A Systematic Review and Meta-analysis

“…In total, 13 studies were included in this review. z All studies were retrospectively performed, consisting of 7 level 4 studies, 1,3,6,14,17,22,29 5 level 3 studies, 11,13,26,30,32 and 1 level 2 study. 2 This search strategy is summarized in Figure 1.…”

“…3,17,26,32 It was found that the workers' compensation group had lower return-to-work rates (50.9%) than the non-workers' compensation group (86%), but the difference only approached significance (P = .089). In addition, Gowd et al 13 and Hawkins et al 14 reported conflicting results, with Gowd et al finding no difference in outcomes between 79 workers' compensation cases and controls, while Hawkins et al noted significantly worse outcomes in their 8 workers' compensation cases. Owing to insufficient detail in work outcome reporting, these 2 studies were not included in meta-analysis.…”

“…Seven studies 3,11,13,17,22,26,29 reported rates of return to previous work as a function of work intensity level. In total, 215 patients were classified as performing work of light intensity; 172, moderate intensity; and 349, high intensity.…”

“…Eight investigations 2,6,13,17,22,26,30,32 reported pre-and postoperative pain or functional outcome assessments in their patient cohorts. In all studies, each functional outcome measure significantly improved between preoperative and follow-up assessments.…”

Low mental health scores are associated with worse patient-reported outcomes and difficulty with return to work and sport after distal biceps repair

“… 3 , 9 , 10 In addition, mental health has been shown to be predictive of patient return to work at full duty after rotator cuff surgery. 11 To our knowledge, there has been no study that has analyzed the association of mental health scores and functional outcome scores after distal biceps repair. We hypothesize that low scores on a validated mental health measure are associated with worse patient-reported outcome measures and increased difficulty with return to work and sport.…”