Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.
Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2018 Nov;27(11):e323-e329. doi: 10.1016/j.jse.2018.05.026. Epub 2018 Jun 28.
The purpose of this study was to determine the effect of preoperative expectations on outcomes after reverse shoulder arthroplasty (RSA). We hypothesized that patients with greater expectations would have better outcomes.
Patients undergoing primary RSA completed the Hospital for Special Surgery's Shoulder Expectations Survey preoperatively. Preoperative and 2-year postoperative clinical outcomes were measured with the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Shoulder Activity Scale (SAS), 36-Item Short Form Health Survey (SF-36), and visual analog scales (VASs). Pearson correlations were used to assess the relationship between the number of expectations and outcomes. Differences in outcomes between those with higher and lower levels of expectations for each expectation question were assessed by independent samples t test. Multivariable linear regression analysis was used to control for potential confounding factors.
We evaluated 135 patients at 2 years postoperatively. Patients had higher expectations for relieving pain, improving self-care, improving ability to perform daily activities, and improving ability to drive or put on a seatbelt. Patients with a greater number of high expectations preoperatively did not have better ASES, SAS, or VAS pain scores postoperatively. However, higher expectations for relieving nighttime pain was associated with ASES (β = 7.0, P = .048) and VAS pain scores (β = -5.9, P = .047) as well as 2-year improvement of VAS pain (β = -6.1, P = .039). Higher expectations for improving the ability to participate in nonoverhead sports was associated with improvements in SAS (β = 2.8, P = .020).
A higher level of expectations for relief of nighttime pain and improving ability to participate in nonoverhead sports is associated with improved outcomes after RSA.
本研究旨在确定术前期望对反肩关节置换术（RSA）后结果的影响。我们假设期望较高的患者会有更好的结果。
接受初次 RSA 的患者在术前完成了特殊外科医院（HSS）的肩部期望调查。使用美国肩肘外科医师协会（ASES）标准肩部评估表、肩部活动量表（SAS）、36 项简明健康调查量表（SF-36）和视觉模拟量表（VAS）测量术前和术后 2 年的临床结果。Pearson 相关性用于评估期望数量与结果之间的关系。通过独立样本 t 检验评估每个期望问题中期望水平较高和较低的患者之间结果的差异。多变量线性回归分析用于控制潜在的混杂因素。
我们在术后 2 年评估了 135 例患者。患者对缓解疼痛、改善自理能力、提高日常活动能力和提高驾驶或系安全带能力的期望较高。术前期望较高的患者术后 ASES、SAS 和 VAS 疼痛评分并没有更好。然而，夜间疼痛缓解的期望较高与 ASES（β=7.0，P=0.048）和 VAS 疼痛评分（β=-5.9，P=0.047）以及 2 年 VAS 疼痛改善（β=-6.1，P=0.039）相关。提高参与非头顶运动能力的期望与 SAS 的改善相关（β=2.8，P=0.020）。
夜间疼痛缓解和提高参与非头顶运动能力的期望水平与 RSA 后结果的改善相关。
