Preoperative Resilience Strongest Predictor of Postoperative Outcome Following an Arthroscopic Bankart Repair

Abstract

Objectives:Resilience, which is a psychometric property related to “hardiness” or the ability to respond to challenging situations, is a recognized predictor in many outcomes’ domains. This has been studied extensively in stressful situations such as military returning from deployment, serious disease, and traumatic injury. To date however, no study has assessed the role of patient resiliency with respect to surgical outcome. The purpose of this study was to assess the role of preoperative resiliency as calculated by the Brief Resiliency Score (BRS) on relevant surgical outcomes, including the time required to return to full unrestricted activity following an arthroscopic Bankart repair. In addition the correlation between pre-operative BRS with post-operative BRS, post-operative Western Ontario Instability Index (WOSI), American Shoulder and Elbow (ASES) and Single Assessment Numeric Evaluation (SANE) scores was also assessed.Methods:This is a retrospective review of prospectively gathered data on 25 consecutive active duty military patients undergoing an arthroscopic Bankart repair for instability. The mean follow-up was 24.3 months (range, 23-27) as the primary outcome was return to unrestricted duty which occurs within the first year post-intervention. There were 24 males and 1 female. All patients were on unrestricted active military duty prior to injuring the operative shoulder. All patients completed BRS, WOSI, ASES, and SANE questionnaires prior to operative intervention. They then completed the same questionnaires at the most recent follow-up as well as an additional questionnaire on military duty status (unrestricted duty, limited duty, medical separation from the military). Patients were divided into low resiliency and high resiliency groups based on a score of <4.0 for low and ≥4.0 for high in the BRS, and their outcomes were compared.Results:All patients had been cleared for return to full-duty or were undergoing a medical separation at final follow-up. There were no differences between groups in demographics, glenoid bone loss, or glenoid track status. Pre-operative BRS was significantly correlated with time to return to full duty, need for medical separation from the military, post-operative WOSI, SANE and ASES scores and change between pre- and post-operative WOSI, ASES and SANE scores. Those patients with high resiliency returned to full duty significantly faster than the low resiliency group (4.4 v 6.7 months, p<0.01), had better post-operative WOSI (86.4% v 48.9%, p<0.01), SANE (92 v 72, p=0.03), ASES scores (91.5 v 67.6, p=0.03) and were 5 times less likely to be medically separated from the military (7.7% v 38.5%, p<0.01). Also, patients with high resiliency had significantly greater improvement comparing pre-operative to post-operative WOSI (44.8% v 20.3%, p=0.04), ASES (22.0 v 7.5, p=0.04) and SANE scores (2.5 v 1.3, p=0.01). There were no patients with a change between pre- and post-operative resiliency classification.Conclusion:Preoperative resiliency was highly predictive of the time req...

The brief resilience scale is associated with pre- and short-term postoperative outcomes following hip arthroscopy

“…Both studies confirmed a positive correlation between high resilience and positive outcomes. 14 It is possible that all of these conditions feed into each other and can play a role in both the cause and effect, causing confounding. For example, prior studies have established a link between exercise and anxiety/depression.…”

“…Though this study cannot specifically establish a causal relationship, it is clear that there exists a relationship between emotional resilience, anxiety and depression, and PROMs, both pre- and postoperatively. Shaha et al 14 has studied resilience in shoulder surgery on 2 distinct patient population, the elderly shoulder arthroplasty and young active military shoulder instability patient. Both studies confirmed a positive correlation between high resilience and positive outcomes.…”

“…12,13 Recent research, which holds resilience and recovery as distinct trajectories, has instead shown that resilience is more common than previously believed and that it usually arises as a normative function of humans' basic adaptational systems. 12,13 Within the field of orthopaedics, Tokish et al 6,14 investigated the role of resilience in 2 patient populations: (1) older total shoulder arthroplasty; and (2) younger military shoulder instability arthroscopy. These studies separated patients into low and high resilience groups and found that high resiliency correlated positively with shoulder-specific patient-related outcomes.…”

“…Within the field of orthopaedics, Tokish et al 6,14 investigated the role of resilience in 2 patient populations: (1) older total shoulder arthroplasty; and (2) younger military shoulder instability arthroscopy. These studies separated patients into low and high resilience groups and found that high resiliency correlated positively with shoulder-specific patient-related outcomes.…”

Utilizing Multidisciplinary Medicine in Pain Management: A Narrative Review

“…Similarly, psychological variables need to be incorporated into the determination of surgical candidacy. Concurrently, researchers are shifting the focus back towards protective psychological factors and the initial findings are quite promising (48)(49)(50)(51). Resiliency is one important construct that has received recent attention as a modifiable, protective factor for chronic pain, and may be addressed within surgical contexts.…”