Department of Orthopaedic Surgery & Physical Performance, University of Rochester Medical Center, Rochester, New York, USA.
Am J Sports Med. 2023 Sep;51(11):2815-2823. doi: 10.1177/03635465231187904. Epub 2023 Aug 8.
Socioeconomic disparities correlate with worse outcomes after arthroscopic rotator cuff repair. However, use of a surrogate to describe socioeconomic disadvantage has been a challenge. The Area Deprivation Index (ADI) is a tool that encompasses 17 socioeconomic variables into a single metric based on census location.
Higher ADI would result in a worse minimal clinically important difference (MCID) for the Patient Reported Outcomes Measurement Information System (PROMIS) and have less improvement in range of motion (ROM) following arthroscopic rotator cuff repair (ARCR).
Cohort study; Level of evidence, 3.
A retrospective review was performed for patients who underwent arthroscopic rotator cuff repair. Patients in the most socioeconomically disadvantaged quartile (ADI) were compared with the least disadvantaged quartile (ADI) in the ability to reach MCID. Demographic and surgical features were assessed for attainment of MCID.
In total 1382 patients were identified who underwent ARCR, of which a total of 306 patients met final inclusion criteria. A higher percentage of patients within the ADI cohort identified as "Black" or "other" race and had government-issued insurance compared with the ADI cohort ( < .05). The ADI cohort had significantly worse postoperative forward flexion compared with the ADI cohort (145.0°± 32.5° vs 156.3°± 23.4°; = .001) despite starting with comparable preoperative ROM ( = .17). Logistic regression showed that ADI was the only variable significant for predicting achievement of MCID for all 3 PROMIS domains, with the ADI cohort having significantly worse odds of achieving MCID Physical Function (odds ratio [OR], 0.31; = .001), Pain Interference (OR, 0.21; = .001), and Depression (OR, 0.28; = .001). Meanwhile, age, sex, body mass index, and smoking history were nonsignificant. Moreover, "other" for race and Medicare insurance were significant for achievement of MCID Depression but not Physical Function or Pain Interference. Finally, ADI was the main feature for predictive logistic regression modeling.
ADI served as the only significant predictor for achieving MCID for all 3 PROMIS domains after arthroscopic rotator cuff repair. Patients who face high levels of socioeconomic disadvantage have lower rates of achieving MCID. In addition, patients with greater neighborhood disadvantage demonstrated significantly worse improvement in active forward flexion. Further investigation is required to understand the role of ADI on physical therapy compliance and to identify the barriers that prevent equitable postoperative care.
社会经济地位的差异与关节镜肩袖修复术后的不良结局相关。然而，使用替代指标来描述社会经济劣势一直是一个挑战。区域剥夺指数（ADI）是一种工具，它将 17 个社会经济变量纳入基于人口普查位置的单一指标。
更高的 ADI 会导致关节镜肩袖修复（ARCR）后患者报告的结果测量信息系统（PROMIS）的最小临床重要差异（MCID）更差，并且活动范围（ROM）的改善更小。
队列研究；证据水平，3 级。
对接受关节镜肩袖修复的患者进行回顾性分析。在达到 MCID 的能力方面，将处于社会经济最不利四分位（ADI）的患者与最不利四分位（ADI）的患者进行比较。评估人口统计学和手术特征以达到 MCID。
共确定了 1382 例接受 ARCR 的患者，其中共有 306 例符合最终纳入标准。与 ADI 队列相比，ADI 队列中有更高比例的患者被认定为“黑人”或“其他”种族，并且拥有政府颁发的保险（<.05）。尽管 ADI 队列的术前 ROM 起始值相当（ =.17），但术后前屈明显较差（145.0°±32.5°比 156.3°±23.4°； =.001）。逻辑回归显示，ADI 是唯一能预测所有 3 个 PROMIS 域达到 MCID 的变量，ADI 队列达到 MCID 物理功能的可能性显著降低（优势比[OR]，0.31； =.001），疼痛干扰（OR，0.21； =.001）和抑郁（OR，0.28； =.001）。同时，年龄、性别、体重指数和吸烟史无显著意义。此外，种族为“其他”和医疗保险为 Medicare 对达到 MCID 抑郁但不是物理功能或疼痛干扰有显著意义。最后，ADI 是预测逻辑回归模型的主要特征。
ADI 是关节镜肩袖修复术后所有 3 个 PROMIS 域达到 MCID 的唯一显著预测因素。面临较高社会经济劣势的患者达到 MCID 的比例较低。此外，邻里劣势较大的患者在主动前屈方面的改善明显较差。需要进一步研究以了解 ADI 对物理治疗依从性的作用，并确定阻碍实现公平术后护理的障碍。
