Preoperative Resilience Strongest Predictor of Postoperative Outcome Following an Arthroscopic Bankart Repair
Notice bibliographique
Résumé
Objectives: Resilience, which is a psychometric property related to “hardiness” or the ability to respond to challenging situations, is a recognized predictor in many outcomes’ domains. This has been studied extensively in stressful situations such as military returning from deployment, serious disease, and traumatic injury. To date however, no study has assessed the role of patient resiliency with respect to surgical outcome. The purpose of this study was to assess the role of preoperative resiliency as calculated by the Brief Resiliency Score (BRS) on relevant surgical outcomes, including the time required to return to full unrestricted activity following an arthroscopic Bankart repair. In addition the correlation between pre-operative BRS with post-operative BRS, post-operative Western Ontario Instability Index (WOSI), American Shoulder and Elbow (ASES) and Single Assessment Numeric Evaluation (SANE) scores was also assessed. Methods: This is a retrospective review of prospectively gathered data on 25 consecutive active duty military patients undergoing an arthroscopic Bankart repair for instability. The mean follow-up was 24.3 months (range, 23-27) as the primary outcome was return to unrestricted duty which occurs within the first year post-intervention. There were 24 males and 1 female. All patients were on unrestricted active military duty prior to injuring the operative shoulder. All patients completed BRS, WOSI, ASES, and SANE questionnaires prior to operative intervention. They then completed the same questionnaires at the most recent follow-up as well as an additional questionnaire on military duty status (unrestricted duty, limited duty, medical separation from the military). Patients were divided into low resiliency and high resiliency groups based on a score of <4.0 for low and ≥4.0 for high in the BRS, and their outcomes were compared. Results: All patients had been cleared for return to full-duty or were undergoing a medical separation at final follow-up. There were no differences between groups in demographics, glenoid bone loss, or glenoid track status. Pre-operative BRS was significantly correlated with time to return to full duty, need for medical separation from the military, post-operative WOSI, SANE and ASES scores and change between pre- and post-operative WOSI, ASES and SANE scores. Those patients with high resiliency returned to full duty significantly faster than the low resiliency group (4.4 v 6.7 months, p<0.01), had better post-operative WOSI (86.4% v 48.9%, p<0.01), SANE (92 v 72, p=0.03), ASES scores (91.5 v 67.6, p=0.03) and were 5 times less likely to be medically separated from the military (7.7% v 38.5%, p<0.01). Also, patients with high resiliency had significantly greater improvement comparing pre-operative to post-operative WOSI (44.8% v 20.3%, p=0.04), ASES (22.0 v 7.5, p=0.04) and SANE scores (2.5 v 1.3, p=0.01). There were no patients with a change between pre- and post-operative resiliency classification. Conclusion: Preoperative resiliency was highly predictive of the time required to return to full, unrestricted military duty. It was also predictive of post-operative subjective and objective outcomes as well as overall improvement between pre- and post-operative outcomes scores. Highly resilient patients were able to return to duty 2 months faster with significantly fewer requiring medical separation from the military than those lacking resiliency.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».