Factors Related to Improved Quality of Life in Operative and Non-operative RCT Patients

OBJECTIVES: To examine factors that influence quality of life (QOL) outcomes for those with full thickness rotator cuff tears based on surgical versus non-surgical intervention. METHODS: A convenience sample of participants (N=212) presenting to an orthopaedic clinic and identified as having full thickness rotator cuff tears were invited to participate in a prospective cohort study. Participants provided baseline demographic information and completed patient satisfaction, pain VAS, shoulder activity level, functional comorbity, WORC and ASES instruments, and the Veterans Rand 12-item health survey (VR-12). Participants were tracked for operative vs. non-operative intervention and completed the same measures as baseline at 4, 8, 16, 32, 48, and 64 weeks. Descriptive and inferential analysis was conducted using SPSS v. 21.0 (IBM Corp, Armonk, NY) Chi-square analysis and student's t-test was used to examine differences between categorical and continuous variables and baseline and 64 week scores. ANOVA was used to test differences between groups. Generalized estimating equations (GEE) were used to examine the effects of fixed factors on quality of life such as gender, BMI, age, diabetes, smoking, tear size, pain VAS, functional comorbidity, ASES, and WORC scores longitudinally from baseline to 64 weeks. RESULTS: Participant demographics consisted of 126 males and 86 females with a mean age of 60 ±9.6. There were 93 non-operative subjects and 119 in the operative group. Baseline characteristics between groups indicated a significant difference in age (p<.001), gender (p<.05), and cause of injury (p<.001). Among baseline scores there were differences in pain VAS (p<.05), shoulder activity level (p<.01), functional comorbidity (p<.05), ASES (p<.05), and WORC (p<.05), with all baseline scores indicating “worse” scores for the operative group. There were no significant differences noted between groups for baseline PCS (p=.508) and MCS (p=.862) scores. Paired samples t-tests within the non-operative group indicate no difference between baseline and 64 week PCS (p=.434) and MCS (p=.203) scores. The operative group PCS and MCS scores were both significantly different from baseline to 64 week scores (p<.001, p<.001) respectively. Between groups results show there was no significant difference in 64 week MCS scores (p=.539), however there was a significant difference in 64 week PCS scores noted (p<.001). Factors predictive of higher MCS scores were non-diabetic (β=4.82, p<.05), non-smoker (β=4.52, p<.05), lower functional comorbidity (β= -1.22, p<.05), higher baseline pain VAS (β=.087, p<.05), and a lower WORC score (β= -.011, p<.001). Factors predictive of higher PCS scores were surgical intervention (β=2.96, p<.01), non-diabetic (β=2.87, p<.05), lower functional comorbidity (β= -1.18, p<.001), higher baseline ASES (β=.128, p<.01), and lower baseline WORC (β= -.005, p<.01). CONCLUSION: Surgical intervention had no effect on MCS score but there was evidence to support the efficacy of operative treatment for improving PCS score. Of these patients that elected operative intervention their long-term QOL outcomes were improved.