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Ruggiero G1, Zanotti G1, Panizzardi L1, Delle Rose G2, Borroni M2, Castagna A2,3, Gatti R1,3
1Humanitas Research Hospital, Physiotherapy Unit, Rozzano (Milan), Italy, 2Humanitas Research Hospital, Orthopedic Surgery of the Shoulder and Elbow Unit, Rozzano (Milan), Italy, 3Humanitas University, Pieve Emanuele (Milan), Italy
Background: Arthroscopic rotator cuff repair (RCR) is one of the most common orthopedic procedures and it is the gold standard treatment of most rotator cuff tears. In the last decades, surgical care widely improves and now post-operative guidelines always include rehabilitation. By evaluate surgery results, patient's satisfaction is considered a relevant outcome. Most of the studies refers high percentage of satisfied patients after RCR at long term follow-up. These positive results were mostly reported without attempting to determine the factors that influence satisfaction or not considering rehabilitation programs.
Purpose: The purpose of this study was to investigate the determinants of subjects' satisfaction after RCR and evaluate the relationship between satisfaction and different physiotherapy approaches in two years follow up.
Methods: 202 subjects who underwent arthroscopic RCR surgery at Humanitas Research Hospital were selected. 100 subjects were excluded for concomitant pathologies or refused to participate to the research. 102 subjects accepted the telephone interview. A single trained physiotherapist did all the interviews and asked about: overall satisfaction (dichotomy question: satisfied or unsatisfied), quality of life questionnaire (EQ-5D), Disabilities of the Arm, Shoulder and Hand (DASH) and subjective opinion on the shoulder functioning (Subjective Shoulder Value -SSV). Rehabilitation program was also investigated asking: how long interviewees attended physiotherapy (less than1 month, 1 to 3 months, 3 to 6 months, more than 6 months), how many treatments had been executed (more or less than 10) and the main physiotherapy approach (manual therapy, assisted or self-managed exercise, instrumental therapy application).
Interviewees' satisfaction was analyzed using Fisher and Wilcoxon tests. Comparison among the three groups of physiotherapy approaches in satisfied interviewees was analyzed by Kruskal-Wallis test.
Results: Out of 102 interviewees (41 men, 61 women; age 55,5±24,7), 99 (97%) declared to be satisfied in medium term follow up (32,7 ±3,9 months). SSV showed the only significant difference between satisfied and unsatisfied interviewees (p= 0.005). Satisfaction was independent to age (p=0.41), gender (p=0.56), functional recovery ( DASH, p=0.13) and quality of life (EQ-5D, p=0.91). 101 interviewees did physiotherapy after surgery and 98 were among the satisfied. 17 subjects did manual therapy, 81 exercises and 3 instrumental therapy. All the subjects who did manual therapy were satisfied. Satisfaction was not related to therapy approach (p=0.09), physiotherapy duration (p= 0.12) and number of treatments.
Conclusion(s): Subjects' satisfaction after RCR is high independently to age, sex, functional recovery and quality of life. Subjective measures, as SSV, better reflects subjects' satisfaction. Moreover, interviewee's satisfaction seems to be independent to physiotherapy approach.
Implications: Subjective measures has to be preferred in assessing satisfaction. Particularly, SSV could be a useful tool to use in clinical practice. All rehabilitative approaches would seem to be useful for promoting satisfaction. These long-term information can be useful in counseling patients regarding the expected results of RCR.
Keywords: Satisfaction, rotator cuff repair, physiotherapy
Funding acknowledgements: No funding
Purpose: The purpose of this study was to investigate the determinants of subjects' satisfaction after RCR and evaluate the relationship between satisfaction and different physiotherapy approaches in two years follow up.
Methods: 202 subjects who underwent arthroscopic RCR surgery at Humanitas Research Hospital were selected. 100 subjects were excluded for concomitant pathologies or refused to participate to the research. 102 subjects accepted the telephone interview. A single trained physiotherapist did all the interviews and asked about: overall satisfaction (dichotomy question: satisfied or unsatisfied), quality of life questionnaire (EQ-5D), Disabilities of the Arm, Shoulder and Hand (DASH) and subjective opinion on the shoulder functioning (Subjective Shoulder Value -SSV). Rehabilitation program was also investigated asking: how long interviewees attended physiotherapy (less than1 month, 1 to 3 months, 3 to 6 months, more than 6 months), how many treatments had been executed (more or less than 10) and the main physiotherapy approach (manual therapy, assisted or self-managed exercise, instrumental therapy application).
Interviewees' satisfaction was analyzed using Fisher and Wilcoxon tests. Comparison among the three groups of physiotherapy approaches in satisfied interviewees was analyzed by Kruskal-Wallis test.
Results: Out of 102 interviewees (41 men, 61 women; age 55,5±24,7), 99 (97%) declared to be satisfied in medium term follow up (32,7 ±3,9 months). SSV showed the only significant difference between satisfied and unsatisfied interviewees (p= 0.005). Satisfaction was independent to age (p=0.41), gender (p=0.56), functional recovery ( DASH, p=0.13) and quality of life (EQ-5D, p=0.91). 101 interviewees did physiotherapy after surgery and 98 were among the satisfied. 17 subjects did manual therapy, 81 exercises and 3 instrumental therapy. All the subjects who did manual therapy were satisfied. Satisfaction was not related to therapy approach (p=0.09), physiotherapy duration (p= 0.12) and number of treatments.
Conclusion(s): Subjects' satisfaction after RCR is high independently to age, sex, functional recovery and quality of life. Subjective measures, as SSV, better reflects subjects' satisfaction. Moreover, interviewee's satisfaction seems to be independent to physiotherapy approach.
Implications: Subjective measures has to be preferred in assessing satisfaction. Particularly, SSV could be a useful tool to use in clinical practice. All rehabilitative approaches would seem to be useful for promoting satisfaction. These long-term information can be useful in counseling patients regarding the expected results of RCR.
Keywords: Satisfaction, rotator cuff repair, physiotherapy
Funding acknowledgements: No funding
Topic: Orthopaedics; Professional issues; Musculoskeletal: upper limb
Ethics approval required: No
Institution: Humanitas Research Hospital
Ethics committee: Ethics Commitee for Human Investigation of Humanitas Research Hospital
Reason not required: Ethics approval was not required because phone interviews are the clinical routine in the hospital were the study was conducted.
All authors, affiliations and abstracts have been published as submitted.
