The inconsistent reporting and effect of resilience on outcomes following shoulder surgery

In recent years, the prevalence of shoulder arthroplasty and arthroscopic rotator cuff repairs has increased. Patients with stable mental health have exhibited better outcomes following shoulder surgery. Resilience is a psychosocial trait defined as the ability to positively adapt in the face of challenging situations, which can be modifiable. The purpose of this study was to perform a systematic review to determine whether resilience is predictive of clinical outcome measures following shoulder surgery.

We performed a systematic review of literature published between January 1, 2014, and June 9, 2024. A comprehensive search of PubMed, MEDLINE, Embase, and Scopus was performed. Nine studies met the inclusion criteria after screening for all studies. A quality assessment was performed using the Methodological Index for Nonrandomized Studies tool. Data extracted included level of evidence, Methodological Index for Nonrandomized Studies score, age, body mass index-, sex, cohort size, final cohort size, mean follow-up, prior surgery(s), preoperative diagnosis, presence of mental health condition, preoperative resilience scores, postoperative resilience scores, resilience stratification groups, preoperative functional outcome scores, postoperative functional outcome scores, preoperative PROM (patient-reported outcome measure) scores, postoperative PROM scores, and complications.

Six studies assessed resilience with rotator cuff repair, and 3 studies focused on shoulder arthroplasty. The final cohort included 1,154 patients with a mean age of 61.6 years. Three different resilience scales were used in the study, including the Brief Resilience Scale, Connor-Davidson Resilience Score, and the Life Orientation Test-Revised. Resilience was noted to have a significant effect on outcomes based on American Shoulder and Elbow Surgeons scores, Penn Shoulder Score, Patient-Reported Outcomes Measurement Information System Global Health 10 score, and Simple Shoulder Test. There was a low rate of significance between resilience and the Single Assessment Numeric Evaluation score and the Visual Analog Scale (VAS) for pain.

Resilience has been shown to correlate with clinical outcome measures following shoulder surgery; however, there is relative inconsistency regarding which clinical outcome measures demonstrate a significant effect on. The relationship between resilience and outcomes following shoulder surgery needs to be further evaluated.