Association of socioeconomic status and physical therapy compliance after arthroscopic shoulder labrum repair.

Abstract

Background: Socioeconomic status has been shown to impact a patient's access to orthopedic care, but outcomes such as compliance with physical therapy and time to return to full activities has not been established. The aim of this study is to investigate the impact of socioeconomic status on physical therapy compliance and return to play time specifically in patients with shoulder instability. The area deprivation index (ADI) is a validated tool using factors from the US Census that measures socioeconomic deprivation in neighborhoods. Our hypothesis is that patients with higher socioeconomic deprivation are more likely to have more missed scheduled physical therapy appointments and a longer return to play after arthroscopic shoulder labrum repair for instability.

Methods: This study included patients who underwent arthroscopic shoulder labrum repair between 2019 and 2023 at a single orthopedic hospital by a single surgeon. Demographic information (race, age, and sex), insurance type, ADI, physical therapy no-show visit rates, and return to play times were recorded.

Results: The cohort included 73 patients, 14 of whom did not have return to play times. A total of 82.2% of the patients were male, 63.0% were White, and the mean age was 24 years. Patients with increasing ADI were significantly more likely not to attend a scheduled physical therapy session (P = .035). No association between ADI and return to play time was found (P = .165). No significant association between insurance type (private vs. Medicaid) and missed scheduled physical therapy appointments (P = .139) and return to play times was found (P = .741).

Conclusion: Increasing socioeconomic deprivation is associated with increased likelihood to miss scheduled physical therapy visits after shoulder instability surgery. These findings elucidate gaps in orthopedic care as postoperative physical therapy is a crucial part in the comprehensive care of shoulder instability.