Journal of Orthopedic Research and Therapy

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Functional Changes during Wait Times in Patients with Rotator Cuff Tears

Qiyun Shi1, 2*, Joy C. MacDermid1,2,3,4, George S. Athwal5, Darren S. Drosdowech5 Kenneth J. Faber5

1Health & Rehabilitation Sciences, Western University, Room 1014, Elborn College, 1201 Western Road, London, Ontario, Canada, N6G 1H1

2Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario, Canada, N6A 3A8

3The School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada, L8S 4L8

4Department of Clinical Epidemiology and Biostatistics, department of Medicine, McMaster University, Hamilton, Ontario, Canada, L8S 4K1

5Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada, N6A 4L6

*Corresponding author: Qiyun Shi, Health & Rehabilitation Sciences, Western University, Room 1014, Elborn College, 1201 Western Road, London, Ontario, Canada, N6G 1H1.E-mail: qshi26@uwo.ca

Received Date: 15 February, 2017; Accepted Date: 20 February, 2017; Published Date: 27 February, 2017

Citation: Shi Q, MacDermid JC, Athwal GS, Drosdowech DS, Faber KJ (2017) Functional Changes during Wait Times in Patients with Rotator Cuff Tears. J Orthop Res Ther 2017: 128. DOI: 10.29011/2575-8241.000128

Background

Rotator cuff tears are common problems that often require surgery. In Canada, there are often wait times for orthopaedic consultation and surgery. The purpose of this study is to evaluate functional changes during the wait times on patients with rotator cuff tears.

Methods

Between January 2003 and April 2008, 135 patients with rotator cuff disorders were recruited from a surgical consultation list. Participants were assessed shoulder external rotation strength and self-reported upper extremity disability questionnaires at baseline and 1, 2, 3, 4, 5, 6, 12 months follow-up till they received surgery. Generalized estimating equations (GEE) were used to model functional changes that occurred during wait-times.

Results

A total of 135 patients (average age=65 year) with rotator cuff disorders were recruited from a surgical consultation list and followed prospectively while waiting for surgery. Participants were assessed for range of motion, shoulder strength, patient-reported pain and disability, as well as health status at baseline and 1, 2, 3, 4, 5, 6, 12 months follow-up till they received surgery. Functional changes in patient-reported outcomes and strength were analyzed. The average wait times of patients to receive surgery was 154 days. Patients with severe injury were more likely to undergo surgery before 3 months. The length of time waiting wait times had a minor impact on self-reported disabilities as long as strength.

Conclusions

Surgeons are triaging patients with more severe problems to receive treatment earlier. We observed patients had small further declines in functions occurring during a six-month surgical wait time. Further studies are needed to explore earlier stage in the clinical course.

Keywords: Rotator Cuff; Time to Surgery; Functional Changes.



Figure 1: Comparison of DASH and WORC score and external rotation ratio changes in 12 months.


 

Characteristics

 

N (%)

Age

  

37-50

10 (7.4)

51-60

30 (22.2)

61-70

58 (43.0)

71-80

26 (19.3)

81-90

11 (0.8)
 

Gender (male)

89 (65)

Affected arm is dominant

83 (62)

Rotator cuff tears by injury

82 (61)

Employment

  

Full time/par time employed

53 (39.3)

Unable to work because of rotator cuff injury

9 (7%)

Homemaker/retired

39 (28.9%)

Missing

34 (25.2%)

Highest education level

  

High school

29 (21.5)

College

33 (24.4)

University and above

33 (24.4)

Missing

40 (29.6)

Wait times (mean, SD)

  

First surgery consultation at HULC (mean,SD)

163 (112) days

Surgery executed (mean,SD)

154 (71) days

Table 1: Characteristics of 135participants

 

 

 

 

Months

 

 

Baseline

1

2

3

4

5

6

12

P value

DASH

41.23

42.84

45.51

43.84

40.79

40.84

38.95

29.89

0.25

(21.34)

(20.59)

(23.28)

(18.84)

(19.78)

(22.92)

(14.64)

(27.81)

WORC

1248.7

1256.9

1219.6

1238.9

1212.7

1168.5

1214.6

777.0

0.07

(496.8)

(481.1)

(518.9)

(533.9)

(567.7)

(539.4)

(243.0)

(644.6)

External rotation ratio Strength

56.22

57.03

55.00

51.55

59.77

66.48

57.10

81.73

0.32

(34.17)

(35.24)

(37.95)

(34.90)

(37.63)

(36.03)

(31.97)

(15.65)

Table 2: Comparison of DASH, WORC and external rotation ratiochanges in 12 months

 

 

DASH

WORC

External rotation ratio strength

 

Adjusted β(95% CI)

P vale

Adjusted OR (95% CI)

P vale

Adjusted OR (95% CI)

P vale

Age

0.7

(0.18, 0.37)

0.001*

0.49

(-0.80, 1.77)

0.46

-0.01

(-0.02, 0.002)

0.14

Gender (female)

0.54

(-1.51, 12.39)

0.13

6.48

(-14.55, 27.50)

0.55

0.08

(-0.09,0.25)

0.38

Affected arm is dominated

7.94

(0.74, 15.15)

0.03*

7.78

(-12.28, 27.86)

0.48

0.001

(-0.15, 0.15)

0.99

Caused by injury

4.34

(-2.30, 10.99)

0.2

17.98

(-0.35, 36.31)

0.06

-0.21

(-0.36, -0.07)

0.004*

Wait times

0.04

(0.03, 0.05)

0.001*

0.08

(0.04, 0.12)

0.001*

-0.03

(-0.08, 0.08)

0.94

SF-12

-0.58

(-0.86, -0.28)

0.001*

-1.28

(-2.08, -0.47)

0.002*

-0.002

(-0.007, 0.004)

0.59

Table 3: Multivariate analyses of DASH, WORC and external rotation ratio strength.

 
 

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