Functional and Radiologic Outcomes of Degenerative Versus Traumatic Full-Thickness Rotator Cuff Tears Involving the Supraspinatus Tendon.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial. PURPOSE: To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects. RESULTS: From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) (P < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (P≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; P = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; P = .934) and additional surgeries (7 [3%]; 7 [3.7%]; P = .723) differed between groups. CONCLUSION: Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.

Development and internal validation of a model predicting patient-reported shoulder function after arthroscopic rotator cuff repair in a Swiss setting.

BACKGROUND: Prediction models for outcomes after orthopedic surgery provide patients with evidence-based postoperative outcome expectations. Our objectives were (1) to identify prognostic factors associated with the postoperative shoulder function outcome (the Oxford Shoulder Score (OSS)) and (2) to develop and validate a prediction model for postoperative OSS. METHODS: Patients undergoing arthroscopic rotator cuff repair (ARCR) were prospectively documented at a Swiss orthopedic tertiary care center. The first primary ARCR in adult patients with a partial or complete rotator cuff tear were included between October 2013 and June 2021. Thirty-two potential prognostic factors were used for prediction model development. Two sets of factors identified using the knowledge from three experienced surgeons (Set 1) and Bayesian projection predictive variable selection (Set 2) were compared in terms of model performance using R squared and root-mean-squared error (RMSE) across 45 multiple imputed data sets using chained equations and complete case data. RESULTS: Multiple imputation using data from 1510 patients was performed. Set 2 retained the following factors: American Society of Anesthesiologists (ASA) classification, baseline level of depression and anxiety, baseline OSS, operation duration, tear severity, and biceps status and treatment. Apparent model performance was R-squared = 0.174 and RMSE = 7.514, dropping to R-squared = 0.156, and RMSE = 7.603 after correction for optimism. CONCLUSION: A prediction model for patients undergoing ARCR was developed using solely baseline and operative data in order to provide patients and surgeons with individualized expectations for postoperative shoulder function outcomes. Yet, model performance should be improved before being used in clinical routine.

Prognostic factors for improvement of shoulder function after arthroscopic rotator cuff repair: a systematic review.

Background: The identification of factors that specify prognostic models for postoperative results should be based on the best scientific evidence and expert assessment. We aimed to identify, map, and evaluate potential prognostic factors for the improvement of shoulder function in patients undergoing arthroscopic rotator cuff repair. Methods: Longitudinal primary studies of arthroscopic rotator cuff repair reporting any multivariable factor analyses for shoulder function improvement with an endpoint assessment of at least 6 months were included. We systematically searched EMBASE, Medline, and Scopus for articles published between January 2014 and June 2021. The risk of bias of included studies and the quality of evidence were assessed using the Quality in Prognosis Studies tool and an adapted Grading of Recommendations, Assessment, Development, and Evaluations framework. Results: Overall, 24 studies including 73 outcome analyses were included. We classified younger age and smaller tear size as probably prognostic for a greater improvement in objective outcomes. Shorter symptom duration, absence of a worker compensation claim, low preoperative level of functional status, and high preoperative pain level were classified as probably prognostic for greater improvement in patient-reported outcome measures. The quality of the synthesized evidence was low. Twenty-one studies had an overall high risk of bias. Conclusion: Six potential prognostic factors for shoulder function after arthroscopic rotator cuff repair were identified. Along with ongoing expert opinion assessments, they will feed into a prognostic model-building process.

Reproducibility and Scientific Integrity of Big Data Research in Urban Public Health and Digital Epidemiology: A Call to Action.

The emergence of big data science presents a unique opportunity to improve public-health research practices. Because working with big data is inherently complex, big data research must be clear and transparent to avoid reproducibility issues and positively impact population health. Timely implementation of solution-focused approaches is critical as new data sources and methods take root in public-health research, including urban public health and digital epidemiology. This commentary highlights methodological and analytic approaches that can reduce research waste and improve the reproducibility and replicability of big data research in public health. The recommendations described in this commentary, including a focus on practices, publication norms, and education, are neither exhaustive nor unique to big data, but, nonetheless, implementing them can broadly improve public-health research. Clearly defined and openly shared guidelines will not only improve the quality of current research practices but also initiate change at multiple levels: the individual level, the institutional level, and the international level.

Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers / Profil clinique et parcours de soins des résidents bénéficiant de l'intervention de l'hospitalisation à domicile en Établissement d'hébergement pour personnes âgées dépendantes et comparaison des interventions selon leur provenance

Background: Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals). Methods: A retrospective study on 1,436 residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. Results: Residents were 88 years old with 69 % of women with functional disability and the care was mainly represented by the complex dressing (68 %). For the care pathway, 65 % of the referrers were from the NH and 35 % from the hospital settings, 33 % of the residents died at the end of the stay in the NH and 25 % were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). Discussion : Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.

Introduction: Les résidents d'Établissement d'hébergement pour personnes âgées dépendantes (Ehpad) présentent un haut risque d'hospitalisation. Afin d'éviter le recours à l'hôpital, l'hospitalisation à domicile (HAD) en Ehpad s'est développée. Cette étude a pour objectifs de caractériser le profil clinique et le parcours de soins des résidents d'Ehpad ayant bénéficié de l'HAD, et de comparer leur profil selon la provenance de l'intervention (Ehpad ou hôpital). Méthodes: Une étude rétrospective des séjours de résidents d'Ehpad ayant bénéficié de l'HAD de l'Assistance publique-Hôpitaux de Paris entre 2014 et 2019 a été mise en place à partir des données du PMSI. Résultats: Les résidents étaient âgés de 88 ans en moyenne avec 69 % de femmes. Ils étaient principalement pris en charge pour des plaies complexes (68 %). Concernant les séjours, 65 % étaient en provenance de l'Ehpad. Les modes de sortie montraient 33 % de décès en Ehpad et 25 % de réhospitalisations. Selon la provenance du séjour, les résidents présentaient un profil clinique et des parcours de soins différents. Discussion/conclusion: L'intervention de l'HAD en Ehpad permet de répondre aux caractéristiques et aux besoins spécifiques des résidents tout en évitant un recours systématique à l'hospitalisation.

From psychiatric hospitals to residential facilities: Characteristics of patients who benefited from an institutional partnership.

OBJECTIVES: The population of older adults is growing fast, especially in Europe and Northern America. Old age is often associated with mental health comorbidities. Moreover, life expectancy of people suffering from psychiatric disorders has increased, but with age-related difficulties, such as loss of independence. This represents a challenge for public health policies, as this population requires specific care and living conditions. As a response, a convention was signed between living facilities for dependent elderly (EHPAD) and the GHU Paris Psychiatry and Neurosciences. The agreement included dedicated places in EHPAD for older patients with psychiatric disorders. The aim of the study was to describe the sociodemographic and clinical characteristics of those patients. METHODS: We conducted a cross-sectional study among patients who applied for an EHPAD admission. RESULTS: Between 2016 and 2019, 163 patients applied for placement in an EHPAD, and 117 were admitted (72%). Applicants were 71 years old on average. Admitted patients were older than non-admitted and lived in different Parisian sectors. Among admitted patients, nine in 10 were single, divorced or widowed, and 64.3% were childless. Almost half of them were schizophrenic or had delusional disorders (46.9%), and 65.3% were considered as moderately dependent. At the time of the study, 89 patients still lived in EHPAD. Almost half of them had anxiety and depressive disorders (48.3%), 19.1% had cognitive disorders, and 42.7% manifested agitation. CONCLUSIONS: Our study highlighted older psychiatric patients' specificities regarding their admission status into long-term living facilities.

[Clinical profile and care pathways of nursing home residents having the intervention of hospital at home and comparison according to the referrers]. / Profil clinique et parcours de soins des résidents bénéficiant de l'intervention de l'hospitalisation à domicile en Établissement d'hébergement pour personnes âgées dépendantes et comparaison des interventions selon leur provenance.

Background : Nursing homes' (NH) residents present a mix of medical, psychological and social needs associated with a high risk of hospitalization. The intervention of the hospitalization at home (HAH) in NH has been implemented in France to better fit the residents' needs and decrease the risk of hospitalization. No study has described the population of residents receiving this intervention. This study aimed to define the profile and the care pathway of residents and compare their characteristics according to the referrals (NH or hospitals). METHODS: A retrospective study on 1,436 residents' stays in the intervention of the Assistance Publique-Hôpitaux de Paris'HAH in Ile de France between 2014 and 2019 was implemented. The Programme de Médicalisation des Systèmes d'Information (PMSI) data was used for the analysis. RESULTS: Residents were 88 years old with 69% of women with functional disability and the care was mainly represented by the complex dressing (68%). For the care pathway, 65% of the referrers were from the NH and 35% from the hospital settings, 33% of the residents died at the end of the stay in the NH and 25% were transferred to hospitals. When the referrer was the hospital, the residents were mainly men (p < 0.001), younger (p < 0.001), receiving more often intravenous treatment and palliative care (p < 0.01) with a higher level of indice of Karnofsky (p < 0.01). When the NH was the referrer, deaths were more frequent, whereas the transfers to hospitals were less common (p < 0.001). DISCUSSION: Residents had complex clinical situation and their care pathway were different according to the referrer. From the NH, the HAH was used to provide more often end of life care, and from hospital setting, the residents received more acute care with a higher risk of readmission. Readmission causes should be analyzed.

Prognostic factors for the occurrence of post-operative shoulder stiffness after arthroscopic rotator cuff repair: a systematic review.

BACKGROUND: Post-operative shoulder stiffness (POSS) is one of the most frequent complications after arthroscopic rotator cuff repair (ARCR). Factors specifying clinical prediction models for the occurrence of POSS should rely on the literature and expert assessment. Our objective was to map prognostic factors for the occurrence of POSS in patients after an ARCR. METHODS: Longitudinal studies of ARCR reporting prognostic factors for the occurrence of POSS with an endpoint of at least 6 months were included. We systematically searched Embase, Medline, and Scopus for articles published between January 1, 2014 and February 12, 2020 and screened cited and citing literature of eligible records and identified reviews. The risk of bias of included studies and the quality of evidence were assessed using the Quality in Prognosis Studies tool and an adapted Grading of Recommendations, Assessment, Development and Evaluations framework. A database was implemented to report the results of individual studies. The review was registered on PROSPERO (CRD42020199257). RESULTS: Seven cohort studies including 23 257 patients were included after screening 5013 records. POSS prevalence ranged from 0.51 to 8.75% with an endpoint ranging from 6 to 24 months. Due to scarcity of data, no meta-analysis could be performed. Overall risk of bias and quality of evidence was deemed high and low or very low, respectively. Twenty-two potential prognostic factors were identified. Increased age and male sex emerged as protective factors against POSS. Additional factors were reported but do require further analyses to determine their prognostic value. DISCUSSION: Available evidence pointed to male sex and increased age as probable protective factors against POSS after ARCR. To establish a reliable pre-specified set of factors for clinical prediction models, our review results require complementation with an expert's opinion.

Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair.

BACKGROUND: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. PURPOSE/HYPOTHESIS: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model's predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. RESULTS: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. CONCLUSION: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

Swiss-wide multicentre evaluation and prediction of core outcomes in arthroscopic rotator cuff repair: protocol for the ARCR_Pred cohort study.

INTRODUCTION: In the field of arthroscopic rotator cuff repair (ARCR), reporting standards of published studies differ dramatically, notably concerning adverse events (AEs). In addition, prognostic studies are overall methodologically poor, based on small data sets and explore only limited numbers of influencing factors. We aim to develop prognostic models for individual ARCR patients, primarily for the patient-reported assessment of shoulder function (Oxford Shoulder Score (OSS)) and the occurrence of shoulder stiffness 6 months after surgery. We also aim to evaluate the use of a consensus core event set (CES) for AEs and validate a severity classification for these events, considering the patient's perspective. METHODS AND ANALYSIS: A cohort of 970 primary ARCR patients will be prospectively documented from several Swiss and German orthopaedic clinics up to 24 months postoperatively. Patient clinical examinations at 6 and 12 months will include shoulder range of motion and strength (Constant Score). Tendon repair integrity status will be assessed by ultrasound at 12 months. Patient-reported questionnaires at 6, 12 and 24 months will determine functional scores (subjective shoulder value, OSS), anxiety and depression scores, working status, sports activities, and quality of life (European Quality of Life 5 Dimensions 5 Level questionnaire). AEs will be documented according to a CES. Prognostic models will be developed using an internationally supported regression methodology. Multiple prognostic factors, including patient baseline demographics, psychological, socioeconomic and clinical factors, rotator cuff integrity, concomitant local findings, and (post)operative management factors, will be investigated. ETHICS AND DISSEMINATION: This project contributes to the development of personalised risk predictions for supporting the surgical decision process in ARCR. The consensus CES may become an international reference for the reporting of complications in clinical studies and registries. Ethical approval was obtained on 1 April 2020 from the lead ethics committee (EKNZ, Basel, Switzerland; ID: 2019-02076). All participants will provide informed written consent before enrolment in the study. TRIAL REGISTRATION NUMBER: NCT04321005. PROTOCOL VERSION: Version 2 (13 December 2019).