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Predictors of Short-Term Patient-Reported Outcome Following Surgical Treatment of Rotator Cuff Pathology

Woollard, Jason (2013) Predictors of Short-Term Patient-Reported Outcome Following Surgical Treatment of Rotator Cuff Pathology. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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The purpose of this dissertation was to systematically review the prognostic evidence for factors that may predict clinical outcome in individuals undergoing rotator cuff repair, determine preoperative factors that can accurately predict outcome in individuals having arthroscopic subacromial decompression with or without rotator cuff repair, and calculate responsiveness for the Western Ontario Rotator Cuff Index and the Disabilities of the Arm, Shoulder and Hand Questionnaire in these individuals.
A preoperative evaluation collected demographic information, history of the shoulder condition, measures of shoulder impairment, shoulder activity level, fear-avoidance levels, depressive symptomatology, and anxiety. Patient-reported outcomes (PROs) included a disease-specific PRO, the Western Ontario Rotator Cuff Index (WORC), and a region-specific PRO, the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). Six months postoperatively, the WORC, DASH and global rating of change were collected.
Logistic regression analysis determined which preoperative variables were able to predict responders from nonresponders. Responders were determined based on a minimum improvement of 17-points on the WORC score and a global rating of change score of at least “quite a bit better” at the 6-month postoperative time point. Linear regression, with the WORC change score used as the dependent variable, provided a secondary analysis to allow comparison of the logistic and linear models. Effect sizes, standardized response means and the sensitivity and specificity of the minimal clinically important difference for both the WORC and DASH were calculated.
Surgery on the dominant shoulder and a score of 25 or less on the work subscale of the Fear-Avoidance Beliefs Questionnaire were the significant predictors in the final logistic model. The accuracy of the model for correctly predicting responders from nonresponders was excellent. Fear-avoidance, as a predictor of outcome, provides a modifiable factor that can be targeted by specific rehabilitation interventions. In the linear model, the WORC change score was predicted by surgery on the dominant arm, modified job duty, and age. Both the WORC and DASH demonstrated high levels of internal responsiveness while external responsiveness could not be accurately assessed due to the preponderance of responders to nonresponders.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairIrrgang, James J
Committee MemberBost, James E
Committee MemberFitzgerald, G Kelley
Committee MemberPiva, Sara Reginasrpst24@pitt.eduSRPST24
Committee MemberRodosky, Mark
Date: 22 January 2013
Date Type: Publication
Defense Date: 17 April 2012
Approval Date: 22 January 2013
Submission Date: 16 December 2012
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 140
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: prognosis rotator cuff outcomes
Date Deposited: 22 Jan 2013 15:00
Last Modified: 15 Nov 2016 14:08


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