Preoperative risk factors for lower physical therapy compliance rates after shoulder arthroplasty

Abstract

BackgroundParticipation in postoperative rehabilitation is thought to be an important step in achieving a good outcome after total shoulder arthroplasty. The effects of common preoperative risk factors on physical therapy compliance are not well defined. This study compared physical therapy compliance rates in patients with and without a history of smoking, mood disorders, and preoperative opioid pain medication use. MethodsA retrospective chart review of primary anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) completed at a single institution from 2010 to 2015 was carried out. Postoperative physical therapy was conducted using a standardized 12-week shoulder arthroplasty program. Preoperative risk factors captured in the electronic medical record were a history of mood disorder, chronic preoperative opioid use, and tobacco use. Compliance rates in the 90-day global period after surgery were calculated by identifying attendance at physical therapy appointments. Compliance rates were then compared by the presence or absence of these risk factors. Two-tailed t-tests and analysis of variance were used to determine the significance of any differences in compliance between groups. ResultsA total of 214 shoulder arthroplasties (92 RTSAs, 122 TSAs) performed by a single surgeon were identified. In the global period after surgery, 82% of all physical therapy visits were attended. There were no statistically significant differences between groups regarding laterality. The overall compliance rates for the RTSA and TSA groups were similar at 83% and 82%, respectively, (P = .66). Patients with a history of mood disorder had a significantly lower compliance rate (76%) than those without (85%, P = .004), patients with a history of smoking had significantly lower compliance rates at 79% vs. 83% (P = .05), and patients with a history of chronic preoperative opioid use showed a statistically insignificant trend toward lower compliance at 78% vs. 84% (P = .06). Forty-two patients had multiple concurrent comorbidities, with a compliance rate of 72%. Patients with multiple comorbidities were significantly less compliant than patients with a single comorbidity (82%, P = .017) or patients with no comorbidities (85% P = .001). ConclusionPatients with mood disorders and a history of tobacco use were significantly less compliant with postoperative physical therapy programs after shoulder arthroplasty. Our data also suggest that the effects of these risk factors may be additive, with patients diagnosed with multiple comorbid conditions having the lowest therapy compliance rate of any group. Patients with the identified comorbidities may benefit from preoperative counseling and management of these risk factors to achieve optimal results after shoulder arthroplasty. Level of evidenceLevel III, Retrospective Prognostic Study