Patient Outcome Following Rehabilitation for Rotator Cuff Repair Surgery: The Impact of Selected Medical Comorbidities

Mary Beth Badke, Michael J. Wooden, Sheila R. Ekedahl, Kevin Fly, William G. Boissonnault

DOI: 10.2519/jospt.2007.2448

STUDY DESIGN: Prospective, multicenter research design. OBJECTIVES: To assess functional and health status outcomes in patients following a physical therapy program after rotator cuff repair surgery, and to determine the impact of selected patient medical comorbidities on rehabilitation outcomes. BACKGROUND: While authors have studied the influence of multiple factors on patient outcomes after rotator cuff repair surgery, little research has been done on the impact of comorbidities, particularly as it relates to establishing an accurate patient prognosis.  METHODS AND MEASURES: One hundred eighteen patients who had recently undergone a rotator cuff repair surgical procedure were recruited at 1 of 30 Physiotherapy Associates, Inc. outpatient clinics located in 13 states. A rehabilitation protocol was implemented and included the following interventions, as indicated: therapeutic exercise, manual therapy, electrotherapeutic modalities, and physical agents. Patient health history factors were documented during the initial examination, including age, race, body mass index, smoking, rotator cuff tear size, type of surgical procedure, and selected medications and comorbidities.  The Disabilities of the Arm, Shoulder, and Hand (DASH), and the Short-Form-36 (SF-36) were completed prior to rehabilitation, at discharge, and 6 months postdischarge. RESULTS: DASH and most SF-36 domain mean scores obtained postrehabilitation were significantly improved from pretherapy scores. Most health status outcomes were maintained at 6-month follow-up, with slight further improvement noted in SF-36 physical dimensions and DASH scores. Having a greater number of comorbidities was associated with worse postrehabilitation SF-36 scores, but not with the DASH shoulder function scores. The mean change scores (difference between prerehabilitation and postrehabilitation status) for the DASH and SF-36 were not significantly different for patients with 0 to 1, 2, or at least 3 or more comorbidities (except for emotional role). In regression analyses, a model with baseline physical function score (P = .0001), age P = .03), and number of comorbidities (P = .003) fitted the data well and explained 38% of the variance in the physical function score at discharge. CONCLUSIONS: A higher number of comorbidities had a negative effect on general health status outcomes but not on shoulder function outcomes at the time of patient discharge following rehabilitation. Despite a negative effect of more comorbidities on health status outcomes, the specific number of medical comorbidities did not affect the overall level of improvement prerehabilitation to postrehabilitation in function and health status. The findings describing the influence of comorbidities on rehabilitation outcomes may assist therapists in establishing accurate patient prognosis.

J Orthop Sports Phys Ther. 2007;37(6):312-319, Epub 16 April 2007. doi:10.2519/jospt.2007.2448 

KEY WORDS: DASH, general health status, prognosis, SF-36, shoulder

This study assesses functional and health status outcomes in patients following a physical therapy program post-rotator cuff repair and determines the impact of selected patient medical comorbidities on rehabilitation outcomes. Despite a negative effect of more comorbidities on health status outcomes, the specific number of medical comorbidities did not affect the overall level of improvement, pre to post-rehabilitation, in function and health status. 

View Full Article