患者的适应能力对关节镜手术的临床效果并无决定性影响，但文献资料存在很大局限性

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-13 DOI:10.1016/j.asmr.2023.100812

Mikalyn T. DeFoor M.D. , Daniel J. Cognetti M.D. , Asheesh Bedi M.D. , David B. Carmack Jr. M.D. , Justin W. Arner M.D. , Steven DeFroda M.D. , Justin J. Ernat M.D., M.H.A. , Salvatore J. Frangiamore M.D., M.S. , Clayton W. Nuelle M.D. , Andrew J. Sheean M.D.

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引用次数: 0

摘要

目的根据《系统综述和荟萃分析首选报告项目》指南，于2022年9月28日对PubMed、Medline、Embase和Science Direct进行了全面检索，以了解关节镜手术后复原力与PRO之间关系的研究。共有887名患者（54%为男性，平均年龄45岁）接受了关节镜手术，包括普通膝关节（3项研究）、单纯膝关节ACLR（1项研究）、肩袖修复（4项研究）和髋关节（1项研究）。在 9 项研究中，有 7 项（78%）采用简明复原力量表作为最常用的复原力测量工具。9 项研究中有 5 项（56%）根据高复原力、正常复原力或低复原力队列对患者进行分层，不同研究的分层阈值各不相同。9 项研究中只有 4 项（44%）在手术前后都测量了患者的 PROs。9 项研究中有 3 项（33%）报告了恢复活动的比率，其中 2 项研究（22%）指出高恢复力与恢复运动/工作的可能性较高有关，特别是在膝关节镜手术后。然而，并没有持续观察到复原力与功能结果之间的重要关联，也没有持续观察到复原力能够预测受试者恢复到受伤前功能水平的能力。然而，现有文献存在很大的局限性，包括样本量不足、根据治疗前的恢复力对患者进行分层缺乏标准化，以及在整个治疗过程中收集的PROs不一致，这些都削弱了大多数结论的说服力。

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Patient Resilience Does Not Conclusively Affect Clinical Outcomes Associated With Arthroscopic Surgery but Substantial Limitations of the Literature Exist

Purpose

To determine whether low resilience is predictive of worse patient-reported outcomes (PROs) or diminished improvements in clinical outcomes after joint preserving and arthroscopic surgery.

Methods

A comprehensive search of PubMed, Medline, Embase, and Science Direct was performed on September 28, 2022, for studies investigating the relationship between resilience and PROs after arthroscopic surgery in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.

Results

Nine articles (level II-IV studies) were included in the final analysis. A total of 887 patients (54% male, average age 45 years) underwent arthroscopic surgery, including general knee (n = 3 studies), ACLR-only knee (n = 1 study), rotator cuff repair (n = 4 studies), and hip (n = 1 study). The Brief Resilience Scale was the most common instrument measuring resilience in 7 of 9 studies (78%). Five of 9 studies (56%) stratified patients based on high, normal, or low resilience cohorts, and these stratification threshold values differed between studies. Only 4 of 9 studies (44%) measured PROs both before and after surgery. Three of 9 studies (33%) reported rates of return to activity, with 2 studies (22%) noting high resilience to be associated with a higher likelihood of return to sport/duty, specifically after knee arthroscopy. However, significant associations between resilience and functional outcomes were not consistently observed, nor was resilience consistently observed to be predictive of subjects’ capacity to return to a preinjury level of function.

Conclusions

Patient resilience is inconsistently demonstrated to affect clinical outcomes associated with joint preserving and arthroscopic surgery. However, substantial limitations in the existing literature including underpowered sample sizes, lack of standardization in stratifying patients based on pretreatment resilience, and inconsistent collection of PROs throughout the continuum of care, diminish the strength of most conclusions that have been drawn.