Woollard Jason D, Bost James E, Piva Sara R, Kelley Fitzgerald G, Rodosky Mark W, Irrgang James J
a Department of Physical Therapy , Chatham University , Pittsburgh , PA , USA.
b Center for Outcomes and Quality Measurement , Children's Healthcare of Atlanta , GA , USA.
Disabil Rehabil. 2017 Oct;39(20):2087-2096. doi: 10.1080/09638288.2016.1219396. Epub 2016 Aug 22.
Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery.
Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome.
Being on modified job duty (OR = .17, 95%CI: 0.03-0.94), and having a worker's compensation claim (OR = 0.08, 95%CI: 0.01-0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR = 11.96, 95%CI: 2.91-49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR = 0.95, 95%CI: 0.91-0.98) and the FABQ_work subscale (OR = 0.92, 95%CI: 0.87-0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR = 8.9, 95%CI 1.75-45.7) and FABQ_work subscale score ≤25 (OR = 15.3, 95%CI 2.3-101.9) remained significant.
Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability. Implications for Rehabilitation Impairment-based shoulder measurements were not strong predictors of patient-reported outcome. Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability. Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels.
极少有研究探讨肩部检查数据或心理社会因素对预测肩袖病变手术后患者报告的残疾情况的预后能力。本研究的目的是检验这些因素的预后价值，以帮助临床医生和患者了解影响术后残疾的术前因素。
招募了62例计划行肩峰下减压术（伴或不伴冈上肌修复）的患者。46例患者有6个月的随访数据。术前收集患者特征、病情史、肩部损伤、心理社会因素以及患者报告的残疾问卷。术后6个月，采用西安大略肩袖指数（WORC）和整体变化评分将受试者分为反应者和无反应者。逻辑回归量化预后能力并创建最简约模型以预测结果。
从事修改后的工作职责（比值比[OR]=0.17，95%置信区间[CI]：0.03 - 0.94）和有工伤赔偿申请（OR = 0.08，95%CI：0.01 - 0.74）会降低良好预后的概率，而优势肩手术（OR = 11.96，95%CI：2.91 - 49.18）会增加良好预后的概率。在检查方面，只有内旋力量受损是显著的单因素预测指标。恐惧回避信念问卷（FABQ）得分（OR = 0.95，95%CI：0.91 - 0.98）和FABQ工作分量表（OR = 0.92，95%CI：0.87 - 0.97）是单因素预测指标。在最终模型中，优势肩手术（OR = 8.9，95%CI 1.75 - 45.7）和FABQ工作分量表得分≤25（OR = 15.3，95%CI 2.3 - 101.9）仍然显著。
优势臂手术在患者报告的残疾方面改善更大，从而增加了手术成功的几率。FABQ工作分量表的预测能力突出了心理社会因素对患者报告的残疾的潜在影响。康复意义基于损伤的肩部测量并不是患者报告结果的有力预测指标。FABQ上恐惧回避行为得分高，尤其是工作分量表得分高，导致自我报告残疾衡量的肩袖手术良好反应的几率低得多。与非优势侧相比，优势肩手术在残疾水平上有更大改善。
