Prospective evaluation of postoperative compliance and outcomes after rotator cuff repair in patients with and without workers' compensation claims

• Published in: Journal of shoulder and elbow surgery 2012-12, Vol.21 (12), p.1728-1733
• Main Authors: Cuff, Derek J., MD, Pupello, Derek R., MBA
• Format: Article
• Language: English
• Subjects: arthroscopic; Arthroscopy - methods; Biological and medical sciences; Diseases of the osteoarticular system; Female; Follow-Up Studies; Hand Injuries - economics; Hand Injuries - physiopathology; Hand Injuries - surgery; healing; Humans; Insurance Claim Reporting - economics; Male; Medical sciences; Middle Aged; Orthopedics; Patient Compliance; Prospective Studies; Quality of Life; range of motion; Range of Motion, Articular; Recovery of Function; Rotator Cuff - physiopathology; Rotator Cuff - surgery; rotator cuff repair; Treatment Outcome; Workers compensation
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2012.03.002

Background This study prospectively evaluated compliance and outcomes after rotator cuff repair in patients with and without Workers' Compensation claims. Materials and methods From December 2007 to January 2010, 42 consecutive patients with Workers' Compensation claims (Work Comp group), and 50 consecutive patients without a Workers' Compensation claim (non-Work Comp group) underwent arthroscopic rotator cuff repair and were enrolled in this study. Compliance with a postoperative protocol of shoulder immobilization and physical therapy was documented. Patients were monitored clinically for a minimum of 12 months. Results Noncompliance with protocol was documented in 22 of 42 patients (52%) in the Work Comp group compared with 2 of 50 (4%) in the non-Work Comp group ( P < .001). The Work Comp group had less improvement in preoperative to postoperative outcome scores for the American Shoulder and Elbow Surgeons (ASES) score (40.4 to 60.1), Simple Shoulder Test (SST) score (3.9 to 6.0) and visual analog scale (VAS) for pain (7.0 to 3.5) compared with the non-Work Comp group (ASES, 41.7 to 89.2; SST, 4.3 to 10.7; VAS, 6.2 to 0.35; P < .0001). The compliant Work Comp patients had more favorable results in final outcome scores (ASES, 73.1; SST, 7.9; VAS, 1.5) than noncompliant Work Comp patients (ASES, 48.4; SST, 4.3; VAS, 5.3; P < .0001). Conclusions Patients with Workers' Compensation claims demonstrated a high rate of postoperative noncompliance (52%) compared with patients without Workers' Compensation claims (4%) after rotator cuff repair. Those Workers' Compensation patients who had no evidence of noncompliance had significant improvements and more favorable outcomes than the noncompliant Workers' Compensation patients.