Patient adherence with postoperative restrictions after rotator cuff repair
This study aimed to measure self-reported patient adherence to postoperative restrictions after rotator cuff repair, to evaluate correlations between adherence and functional outcome, and to identify possible indicators of poor adherence. We believed that poor adherence would correlate with poor functional outcome.
Fifty consecutive patients undergoing repair for rotator cuff tears were included and instructed to wear an abduction brace for 6 weeks after surgery. Functional evaluations, including American Shoulder and Elbow Surgeons score, University of California–Los Angeles shoulder score, and Simple Shoulder Test, were made preoperatively and postoperatively. Patients commented on their adherence with a medical adherence measurement questionnaire.
Average adherence was 88% (range, 59.2-100). There were no significant correlations between adherence and improvement in American Shoulder and Elbow Surgeons, University of California–Los Angeles, or Simple Shoulder Test scores after rotator cuff repair (P = .06245, .5891, and .7688). Of the patient demographics analyzed, only smoking status had a positive effect on adherence (P = .00432; coefficient, 9.867). All other demographics, including hand dominance, mechanism of injury, repair complexity, comorbidities, living status, employment status, and age, had no significant effect on self-measured adherence to postoperative restrictions (P = .7876, .5889, .6444, .4190, .0609, .4171, .5402).
Patients' self-reported adherence did not correlate with shoulder outcome as measured on any of 3 functional outcome scores.
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ABSTRACT: To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. Level II, randomized controlled trial.Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2012; 28(1):34-42. DOI:10.1016/j.arthro.2011.07.012
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ABSTRACT: Adherence to (non)pharmacological treatment is important in heart failure (HF) patients, since it leads to better clinical outcome. Although self-reported and objectively measured medication adherence in HF patients have been compared in previous studies, none of these studies have used an evidence-based cutpoint to differentiate between adherence and non-adherence. In 37 HF patients (mean age 68 ± 10 years, 27 % female, 40 % NYHA functional class III-IV), medication (ACEi/ARB) adherence was objectively measured using the Medication Event Monitoring System (MEMS). Adherence to and importance of taking medication was also assessed by self-report using the Revised HF Compliance Questionnaire. All patients reported that adherence was (highly) important to them and that they 'always' took their medication as prescribed (i.e. 100 % adherence). However, when measured by the MEMS, only 76 % of all patients were adherent. Non-adherent patients more often had a complex medication regimen (78 % vs. 21 %, P < .01), more often depressive symptoms (75 % vs. 29 %, P = .04) and a shorter history of HF (8 vs. 41 months, P = .04), compared with adherent patients. Medication adherence measured by the MEMS was remarkably lower than self-reported adherence. Given the evidence of its importance, further efforts are needed to improve adherence to the pharmacological regimen in HF patients.Netherlands heart journal: monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation 04/2012; 20(7-8):313-9. DOI:10.1007/s12471-012-0283-9
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ABSTRACT: To investigate the effect of a range of demographic and psychosocial variables on medication adherence in chronic obstructive pulmonary disease (COPD) patients managed in a secondary care setting. A total of 173 patients with a confirmed diagnosis of COPD, recruited from an outpatient clinic in Northern Ireland, participated in the study. Data collection was carried out via face-to-face interviews and through review of patients' medical charts. Social and demographic variables, co-morbidity, self-reported drug adherence (Morisky scale), Hospital Anxiety and Depression (HAD) scale, COPD knowledge, Health Belief Model (HBM) and self-efficacy scales were determined for each patient. Participants were aged 67 ± 9.7 (mean ± SD) years, 56 % female and took a mean (SD) of 8.2 ± 3.4 drugs. Low adherence with medications was present in 29.5 % of the patients. Demographic variables (gender, age, marital status, living arrangements and occupation) were not associated with adherence. A range of clinical and psychosocial variables, on the other hand, were found to be associated with medication adherence, i.e. beliefs regarding medication effectiveness, severity of COPD, smoking status, presence of co-morbid illness, depressed mood, self-efficacy, perceived susceptibility and perceived barriers within the HBM (p < 0.05). Logistic regression analysis showed that perceived ineffectiveness of medication, presence of co-morbid illness, depressed mood and perceived barriers were independently associated with medication non-adherence in the study (P < 0.05). Adherence in COPD patients is influenced more by patients' perception of their health and medication effectiveness, the presence of depressed mood and co-morbid illness than by demographic factors or disease severity.European Journal of Clinical Pharmacology 04/2012; 68(10):1365-73. DOI:10.1007/s00228-012-1279-5