Livesey Michael G, Weir Tristan B, Addona Jacqueline L, Curto Ryan A, Apte Anuj, Hughes Marcus, Enobun Blessing, Henn R Frank, Hasan S Ashfaq, Gilotra Mohit N
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Am J Sports Med. 2023 Jan;51(1):179-186. doi: 10.1177/03635465221131984. Epub 2022 Nov 9.
Perioperative education and socioeconomic factors influence patient behavior. Recent evidence has suggested that sling compliance is associated with improved outcomes after shoulder surgery; it is important to investigate factors that influence sling compliance.
To determine the associations between postoperative sling wear and patients' understanding of sling necessity, postoperative home assistance, and social deprivation.
Cohort study; Level of evidence, 2.
A total of 66 patients were prospectively enrolled from 2018 to 2020 if they were ≥18 years of age and undergoing shoulder surgery requiring a sling for at least 1 month postoperatively. Sling wear was measured using a temperature-sensing device. At 6 weeks postoperatively, patients' understanding for sling necessity was determined by their response to a question on the Medical Adherence Measure questionnaire, "Why did you have to wear a shoulder sling?" The Patient Understanding Grading Scale (PUGS) was developed to quantify patient responses. PUGS was graded 1 to 3, with grade 1 corresponding to the least technical knowledge. Patient characteristics, social deprivation (Area Deprivation Index [ADI]), and home assistance were additionally analyzed.
There were no significant differences in baseline characteristics between patients when stratified by PUGS grade. Multivariable linear regression analysis for total hours of sling wear per week showed that patients with PUGS grade 2 (β, 48.2 hours; = .007) and grade 3 (β, 59.5 hours; = .003) wore their slings significantly more than grade 1 patients. Patients with home assistance had significantly greater day hours (73.5 ± 33.0 vs 44.0 ± 24.5 hours; .037) of sling wear per week, but there was no difference in night sling hours. Patients older than 60 years wore their slings significantly more, while men and those with a higher body mass index (BMI) wore their slings significantly less. ADI was not significantly associated with sling wear.
This study demonstrates that patients with greater understanding for sling necessity, those with home assistance, and patients >60 years have greater sling wear, while male patients and those with a higher BMI have lower sling compliance. ADI was not a significant contributor.
围手术期教育和社会经济因素会影响患者的行为。最近的证据表明，佩戴吊带与肩部手术后改善的预后相关；研究影响吊带佩戴依从性的因素很重要。
确定术后吊带佩戴与患者对吊带必要性的理解、术后家庭协助以及社会剥夺之间的关联。
队列研究；证据等级，2级。
2018年至2020年期间，前瞻性纳入了66例年龄≥18岁且接受肩部手术且术后至少需要佩戴吊带1个月的患者。使用温度感应装置测量吊带佩戴情况。术后6周，通过患者对医疗依从性测量问卷中“你为什么要佩戴肩部吊带？”这一问题的回答来确定患者对吊带必要性的理解。制定了患者理解分级量表（PUGS）来量化患者的回答。PUGS分为1至3级，1级对应技术知识最少。此外，还分析了患者特征、社会剥夺（地区剥夺指数[ADI]）和家庭协助情况。
按PUGS分级分层时，患者的基线特征无显著差异。对每周吊带佩戴总时长进行多变量线性回归分析显示，PUGS 2级（β，48.2小时；P = 0.007）和3级（β，59.5小时；P = 0.003）的患者佩戴吊带的时间明显多于1级患者。有家庭协助的患者每周吊带佩戴的白天时长显著更长（73.5±33.0小时对44.0±24.5小时；P = 0.037），但夜间吊带佩戴时长无差异。60岁以上的患者吊带佩戴时间明显更长，而男性和体重指数（BMI）较高的患者吊带佩戴时间明显更短。ADI与吊带佩戴无显著关联。
本研究表明，对吊带必要性理解更好的患者、有家庭协助的患者以及60岁以上的患者吊带佩戴时间更长，而男性患者和BMI较高的患者吊带佩戴依从性较低。ADI不是一个重要因素。
