Motivation of Shoulder Surgery Patients for Rehabilitation (original) (raw)
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The development of the Patient Expectations of Shoulder Surgery survey
Journal of shoulder and elbow surgery, 2017
Patient satisfaction after a surgical procedure is dependent on meeting preoperative expectations. There is currently no patient expectations survey available for patients undergoing shoulder surgery that is validated, reliable, and easy to use in daily practice. The aim of this study was to develop a Patient Expectations of Shoulder Surgery (PESS) survey. In 315 patients, answers to an open-ended question about patient expectations were collected before shoulder surgery to develop the PESS survey. Patients' expectations of the PESS survey were associated with clinical outcome (change of Disabilities of the Arm, Shoulder, and Hand score). Content validity was assessed by a panel of 10 patients scheduled for shoulder surgery, and test-retest reliability was evaluated. Six items were included in the PESS survey: pain relief, improved range of motion, improved ability to perform daily activities, improved ability to perform work, improved ability to participate in recreational acti...
Social Science & Medicine, 2019
The aim of this prospective study was to examine the utility of an integrated model comprising constructs from self-determination theory (SDT) and the theory of planned behavior (TPB) in predicting adherence to a post-surgery rehabilitation program in patients receiving anterior cruciate ligament (ACL) reconstruction. Constructs of the integrated model measured at baseline were expected to predict patients' rehabilitation adherence two months later. Method: Patients (N = 121, M age = 27.62, range = 18-53; 36.66% female) scheduled to have ACL reconstruction surgery within two months were recruited from a Hong Kong public hospital. At baseline and twomonth follow-up, patients completed measures of perceived autonomy support from doctors and physiotherapists and treatment motivation from SDT, social cognition constructs from the TPB factors, and adherence to the postsurgery rehabilitation program recommended by their surgeon. Results: Path analysis displayed good goodness-of-fit of the proposed model with the data (χ2 = 11.47 (df = 9), CFI = 0.98, TLI = 0.93, RMSEA = 0.06 [90% CI = 0.00; 0.10]) after controlling for age, gender, time of surgery, post-surgery rehabilitation, and injury severity. Consistent with hypotheses, perceived autonomy support from physiotherapist and autonomous treatment motivation directly and indirectly predicted the TPB constructs and treatment adherence. However, there was no association between perceived autonomy support from doctors and autonomous motivation. Conclusion: The integrated model was effective in explaining the psychological processes that relate to medical adherence. Findings also highlight the importance of the autonomy support from physiotherapists and provide evidence for potential intervention targets.
Do psychological factors affect outcomes in musculoskeletal shoulder disorders? A systematic review
2021
Background Psychological factors may impact recovery in patients undergoing treatment for shoulder complaints. The aim of this review is to systematically analyse the evidence for the effect of modifiable psychological factors (MPF) on outcome, for patients with musculoskeletal shoulder disorders undergoing conservative or surgical treatment. MPF refers to factors that may change with intervention. Methods This is a systematic literature review. Five databases searched (MEDLINE, CINAHL, Cochrane Library, Embase and PsycInfo), for longitudinal studies investigating the influence of MPF on prognosis of patients with shoulder disorders, all diagnoses, undergoing clinical interventions (conservative or surgical). Level of evidence was determined using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Moderate and high quality evidence was included. We extracted all MPF, categorized constructs into the following domains: beliefs (self-efficacy, expectation of recovery), cop...
Musculoskeletal Care, 2020
Introduction: The prevalence of shoulder arthroplasty (SA) is rising but there is limited research evaluating rehabilitation following SA and whether there is an optimal approach remains unknown. The aim of this study was to understand current NHS practice for rehabilitation following SA as a platform for conducting much needed further research. Methods: Two reviewers independently undertook electronic searches for publicly-available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following SA, for example duration of immobilisation. One reviewer extracted data and a second reviewer verified this. Ethical Approval: Not required. Results: 43 PIS from 40 Trusts were identified. 24 referred to more than one type of arthroplasty (Anatomic, Reverse, Hemiarthroplasty), but did not describe different approaches to rehabilitation based on prosthesis type. 25 PIS provided some instruction regarding movement restrictions, which varied considerably. All PIS referred to post-operative immobilisation, typically with a sling, with median duration of four weeks (range 0 to 8). 34 PIS reported commencing passive exercise immediately. Median time to commencing active exercise was four weeks (range 1 to 6) and five weeks (range 1 to 16) for resisted exercise. Median time expected to return to driving was 6 weeks (range 3 to 12) and general work 12 weeks (range 3 to 26). Conclusion: This study has highlighted significant heterogeneity between rehabilitation approaches following SA, not previously reported in the UK, with a lack of specific rehabilitation PIS for different prosthesis types. Our results will facilitate evaluation of rehabilitation strategies in future research.
Communications medicine, 2023
Background Patient motivation is an important determinant of rehabilitation outcomes. Differences in patients' and clinicians' perceptions of motivational factors can potentially hinder patient-centered care. Therefore, we aimed to compare patients' and clinicians' perceptions of the most important factors in motivating patients for rehabilitation. Methods This multicenter explanatory survey research was conducted from January to March 2022. In 13 hospitals with an intensive inpatient rehabilitation ward, 479 patients with neurological or orthopedic disorders undergoing inpatient rehabilitation and 401 clinicians, including physicians, physical therapists, occupational therapists, and speech-languagehearing therapists, were purposively selected using inclusion criteria. The participants were asked to choose the most important factor motivating patients for rehabilitation from a list of potential motivational factors. Results Here we show that realization of recovery, goal setting, and practice related to the patient's experience and lifestyle are the three factors most frequently selected as most important by patients and clinicians. Only five factors are rated as most important by 5% of clinicians, whereas nine factors are selected by 5% of patients. Of these nine motivational factors, medical information (p < 0.001; phi = -0.14; 95% confidence interval = -0.20 to -0.07) and control of task difficulty (p = 0.011; phi = -0.09; 95% confidence interval = -0.16 to -0.02) are selected by a significantly higher proportion of patients than clinicians. Conclusions These results suggest that when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to using the core motivational factors supported by both parties.
Journal of Orthopaedic & Sports Physical Therapy, 2002
A prospective unblinded randomized clinical trial. Objectives: To compare the effectiveness of 2 types of home program instruction, videotape versus personal instruction by a physical therapist, on subjective outcomes and exercise compliance following arthroscopic repair of a full-thickness rotator cuff tear. Background: Advances in orthopedic surgery and rehabilitation have placed increased emphasis on home exercise programs. Therefore, assessing the effectiveness of different methods of home program instruction is important. Methods and Measures: Patients who consented to undergo surgical repair were randomly assigned to either a videotape or personal instruction group. A self-reported compliance log categorized subjects as fully compliant, partially compliant, or noncompliant. The Shoulder Pain and Disability Index and the University of Pennsylvania Shoulder Scale scores were obtained from subjects preoperatively and at 12, 24, and 52 weeks postoperatively. The null hypotheses that neither group would have better outcomes as measured by 2 shoulder outcome scales at any level of compliance over 4 levels of time, were assessed by 2 separate 2×3×4 multiple analyses of variances (MANOVAs), 1 for each outcome measure (␣ = 0.025). Results: Neither MANOVA was significant and the null hypotheses were not rejected. The main effect of time (number of weeks postsurgery) was significant across all time intervals for both outcome measures (PϽ0.0005). Conclusions: With a therapist available for questions, patients who utilized the videotape method for their home program instruction had self-reported outcomes equal to patients instructed in their home program personally by a physical therapist. Self-reported compliance with the rehabilitation program had little effect on the outcomes.
RESEARCH ARTICLE Disability and satisfaction after Rotator Cuff
2013
Background: Rotator-cuff pathology is the most common cause of pain and disability in the shoulder. Examining the combined effect of biological and societal factors on disability would potentially identify existing differences between men and women with rotator cuff pathology which would help to provide suggestions for better models of care. Purpose of this study was to determine the overall differences in disability between men and women and to examine the relationship between factors that represent sex (biological factors) and gender (non-biological factors) with disability and satisfaction with surgical outcome 6 months after rotator cuff surgery. Methods: Patients with impingement syndrome and/or rotator cuff tear who underwent rotator cuff surgery completed the Western Ontario Rotator Cuff (WORC) index, the American Shoulder & Elbow Surgeons (ASES) assessment form, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measures prior to surgery and 6 month...
Correlation of Subjective and Objective Measures Before and After Shoulder Arthroplasty
Orthopedics, 2013
The degree to which subjective patient-reported measures reflects objective findings or how well subjective and objective measures reflect patient satisfaction is not well established. The purpose of this study was to determine the correlation between such measures before and after shoulder arthroplasty. A group of 174 patients (93 total shoulder arthroplasty and 81 reverse shoulder arthroplasty) were prospectively evaluated pre-and postoperatively (mean follow-up, 49 months) with the following subjective measures: American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 36 (SF-36) summary scores, and patient satisfaction. Objective measures included Biodex isometric strength and videotaped range of motion. The objective measures were combined to derive 1 number representative of the overall shoulder function. All measures improved from their preoperative statuses except the SF-36 physical component summary in patients undergoing revision and the SF-36 mental component summary in patients undergoing primary reverse shoulder arthroplasty. A patient satisfaction score of 5 or more was seen in 89% of patients. Preoperatively, a significant (P,.05) correlation existed between the American Shoulder and Elbow Surgeons and the Simple Shoulder Test (r50.546), American Shoulder and Elbow Surgeons score and SF-36 physical component summary (r50.407), and Simple Shoulder Test and SF-36 physical component summary (r50.479). Objective measures had lower correlations (r,0.4) with subjective scores. Postoperatively, the correlation improved among all measures. Patient satisfaction correlated more with subjective than objective measures. Subjective measures had relatively low correlations with objective measures. Improvements in the current measures are necessary to provide evidence-based comparisons of the effectiveness of shoulder arthroplasty.
In the past, measures of active range of motion and strength testing were deemed sufficient to "prove" the efficacy of treatment interventions. In the current outcomes milieu, however, the focus has shifted to patientcentered assessment (ie, patients' ability to perform activities that are personally relevant). We report results from a study with patients in the private practice of a shoulder surgeon. In this study we evaluated the relationship between impairment measures and scores from several shoulder outcome scales. In addition, we examined transcripts of interviews with shoulder patients regarding the impact of shoulder problems on their lives. One hundred eight persons participated in a randomized trial of home exercise instruction after arthroscopic repair of rotator cuff tears. Two impairment measures were used-strength estimates obtained by use of a Nicholas electronic dynamometer and range of motion in the standing position. Selfreported outcomes were measured by use of the Shoulder Pain and Disability Index (SPADI) and the University of Pennsylvania (UPenn) Shoulder Scale. Pearson correlation coefficients were calculated to estimate the associations between scores on impairment measures and self-report measures. R 2 values were calculated to estimate the proportion of variance shared by impairment and self-report scores. We found that the linear relationship between impairment scores and patientreported outcomes was quite low, explaining as little as 8% of the total variance. Qualitative analysis of patient interviews suggests that patients distinguish between their impairment and their status on personally relevant outcomes. Future research should evaluate the nature of patient judgments of shoulder health outcomes. (J Shoulder Elbow Surg 2005;14:95S-98S.)