Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2023 Jul;32(7):1392-1400. doi: 10.1016/j.jse.2023.02.127. Epub 2023 Mar 21.
Prior studies have failed to show differences in functional outcomes for patient-reported sling use after rotator cuff repair. Temperature-sensing devices are used to more accurately measure brace adherence. The purposes of this study were to quantify actual sling adherence and its predictors and to establish whether increased sling adherence is associated with improved functional and image-based outcomes.
We performed a prospective cohort study of 65 patients undergoing shoulder surgery requiring ≥4 weeks of postoperative sling use. Temperature-sensing devices were implanted in the slings to monitor sling adherence. Patient-reported sling adherence was determined from a questionnaire. Patients were considered 80% adherent if they wore the sling 16 h/d (112 h/week) when 20 h/d was prescribed. The primary outcomes were patient-reported and actual sling adherence, patient-reported outcomes (American Shoulder and Elbow Surgeons score and visual analog scale pain score) within 12 months postoperatively, and image-based failure based on ultrasound or radiography at 6 weeks and 1 year postoperatively.
Patient-reported sling adherence was highly sensitive (82.8%), was poorly specific (28.6%), had low accuracy (53.1%), and was weakly correlated with actual sling adherence (r = 0.32, P = .009). On multivariable logistic regression analysis, male patients were 91% less likely than female patients to be adherent with sling use (odds ratio, 0.09; 95% confidence interval [CI], 0.02-0.42; P = .002). Additionally, obese and morbidly obese patients were 88% (95% CI, 0.02-0.84; P = .033) and 98% (95% CI, 0.002-0.27; P = .003), respectively, less likely than non-obese patients to adhere to sling wear postoperatively. After we controlled for surgical procedure, visual analog scale pain scores were significantly better at 6 weeks (β = -1.47; 95% CI, -2.88 to -0.05; P = .04) and 3 months (β = -1.68; 95% CI, -3.28 to -0.08; P = .04) if patients adhered to sling wear. A receiver operating characteristic curve showed that 13.6 hours and 15.4 hours of daily sling wear optimized image-based outcomes at 6 weeks (failure rate, 0% vs. 16%; P = .01) and 1 year (failure rate, 3% vs. 28%; P = .008) postoperatively, respectively.
The results of this study demonstrate that patient-reported sling adherence is unreliable, adherence can be predicted by female sex and lower body mass index, and increased sling adherence is associated with improved early pain scores and image-based outcomes. These data can help inform future studies using postoperative sling protocols as patient-reported sling adherence is not an accurate method to assess sling use.
先前的研究未能显示肩袖修复后患者报告的吊带使用在功能结果上的差异。温度感应装置用于更准确地测量支架的贴合度。本研究的目的是量化实际吊带的贴合度及其预测因素，并确定增加吊带的贴合度是否与改善功能和基于图像的结果相关。
我们对 65 名需要术后使用吊带≥4 周的肩部手术患者进行了前瞻性队列研究。温度感应装置被植入吊带中以监测吊带的贴合度。如果患者在规定的 20 小时/天（112 小时/周）的情况下每天佩戴吊带 16 小时（16 小时/天），则认为患者的吊带佩戴率为 80%。主要结局是术后 12 个月内患者报告的和实际的吊带佩戴率、患者报告的结果（美国肩肘外科评分和视觉模拟评分疼痛）以及术后 6 周和 1 年的基于超声或放射学的图像失败。
患者报告的吊带佩戴率具有较高的敏感性（82.8%），但特异性较低（28.6%），准确性较低（53.1%），与实际吊带佩戴率的相关性较弱（r=0.32，P=0.009）。在多变量逻辑回归分析中，男性患者比女性患者更不可能坚持使用吊带（比值比，0.09；95%置信区间[CI]，0.02-0.42；P=0.002）。此外，肥胖和病态肥胖患者比非肥胖患者分别更不可能（95% CI，0.02-0.84；P=0.033）和更不可能（95% CI，0.002-0.27；P=0.003）坚持术后佩戴吊带。在我们控制了手术程序后，在 6 周（β=-1.47；95%CI，-2.88 至-0.05；P=0.04）和 3 个月（β=-1.68；95%CI，-3.28 至-0.08；P=0.04）时，视觉模拟评分疼痛显著更好，如果患者坚持佩戴吊带。受试者工作特征曲线显示，每天佩戴吊带 13.6 小时和 15.4 小时可优化术后 6 周（失败率，0%比 16%；P=0.01）和 1 年（失败率，3%比 28%；P=0.008）的图像结果。
本研究结果表明，患者报告的吊带佩戴率不可靠，可通过女性性别和较低的身体质量指数来预测，增加吊带的佩戴率与改善早期疼痛评分和基于图像的结果相关。这些数据可以帮助指导未来的研究使用术后吊带方案，因为患者报告的吊带佩戴率不是评估吊带使用的准确方法。
