Postoperative psychological factors and quality of life but not shoulder brace adherence affect clinical outcomes after arthroscopic rotator cuff repair

Background: Despite the high prevalence, there is no consensus for postsurgical management after rotator cuff repair. We aimed to assess the impact of psychological well-being on patients who underwent rotator cuff repair. We also investigated correlations and possible predictors between patient demographics and adherence to the use of the shoulder brace and outcomes in terms of shoulder functionality and quality of life. Methods: We conducted a retrospective study with prospective data collection enrolling 120 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair. Each patient was clinically evaluated after a mean follow-up of 24.2 (±9.8) months using 1) the Disability of the Arm, Shoulder and Hand (DASH) scale, 2) the Hospital Anxiety and Depression Scale (HADS), 3) the Rotator Cuff Quality of Life (RC-QoL), 4) the Visual Analogue Scale (VAS), and 5) the Medical Adherence Measure (MAM). Results: The final sample consisted of 100 patients (45 female, 45%) averaging 60.9 (±8.5) years. The average brace wearing time was 3.4 (±0.6) weeks, with an adherence superior to 80% in 84% of cases, and 96% of patients were living with family members. The mean postoperative DASH scores were 20.1 (±16.7), 23.4 (±25), and 18.9 (±21.5) for the general, work, and sport sections, respectively. The mean MAM score reached 72.5 (± 14.2) points, and the RC-QoL mean score was 30.4% (±20.5). The HADS-A and HADS-D scores' continuous mean values were 5.1 (±3.4) and 3.9 (±3.6), respectively. The DASH, HADS-A, HADS-D, and RC-QoL scores directly correlated with each other, and all these questionnaires directly correlated with the VAS scores. Moreover, we found a direct correlation (r=0.204, p=0.033) between the female sex and adherence to the brace and a direct correlation (r=0.242, p=0.015) between adherence to the brace and the number of weeks it was worn according to the medical recommendation. A correlation between lower educational qualifications and poorer outcomes was found. No correlation emerged between adherence to the brace and functional results. According to the regression analysis, diabetes was found to be a predictor of worse postoperative DASH scores (β=0,245, p=0,028). Conclusion: A lower perceived quality of life was associated with worse functional results, anxiety and depression symptoms, and pain after rotator cuff repair surgery. The adherence to the use of the shoulder brace was associated with the female sex and a longer prognosis, but no correlation emerged between adherence to the brace and functional outcomes.