| Description |
Rotator cuff repair (RCR) is a common intervention for painful and functionally-limiting rotator cuff tears. Nevertheless, several important aspects influencing postoperative rehabilitation are still unknown, including the ideal timing of rehabilitation, the impact of psychosocial factors, and key predictors of patient satisfaction. Controversies exist regarding whether Early Rehabilitation or Delayed Rehabilitation results in better clinical outcomes following RCR. The aim of the first research study was to evaluate the difference in the cost-effectiveness of Early versus Delayed Rehabilitation from a payer perspective, using a decision tree cost-utility analysis with a 1-year time horizon. Utility values were identified from the literature, while costs and probabilities were gathered from regional claims data. At all willingness-to-pay levels, Early Rehabilitation was the dominant strategy, with higher effectiveness and lower costs compared to Delayed Rehabilitation. The results of this study may help inform payer policy to justify the added rehabilitation-specific costs of Early intervention. Pain catastrophizing has been named an important psychological predictor of pain in orthopedic populations. In the second study the relationship between the pain catastrophizing scale (PCS) and functional disability was investigated with hierarchical linear regression using first the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) at 6 months and then met-expectations as the dependent variable. The results of the hierarchical regressions for both 6-month DASH and met-expectation scores indicated that the addition of the PCS-baseline score significantly improved model fit after controlling for age, tear size, and DASH-baseline. The addition of psychologically-informed treatment to rehabilitation may be beneficial in high catastrophizing patients in this population. The influence of preoperative pain catastrophizing has not previously been examined in relation to patient satisfaction. The purpose of the third study was to investigate the relationship between age, functional comorbidity index (FCI), pain, disability, and pain catastrophizing on short-term patient satisfaction and acceptable symptoms following arthroscopic rotator cuff repair using logistic regression. As baseline scores on the FCI and PCS increase, the odds of achieving satisfaction or patient-acceptable symptoms at 6-months decrease. Providers should consider comorbidities and catastrophizing in the treatment of patients undergoing RCR. |
