Background
Methods
Operationalizing Sex and Gender
Outcome Measures
Demographic, History-Related, Clinical, Radiological and Surgical Factors
Statistical Analysis
Results
Overall Differences between Men and Women
Variables | Women(%) | Men(%) | Statistics P values |
---|---|---|---|
Age (Mean, SD)
| 59.00 (11.07) | 54.85(10.47) |
t value: 2.51
p = 0.013
|
Range | 36–87 | 32–78 | ES:0.39 (0.08–0.69) |
BMI | |||
• Normal < 25 | 22 (26%) | 11 (13%) |
χ
2
: 9.027
|
• Overweight (25.0–29.99) | 26 (30%) | 44 (52%) |
P = 0.011
|
• Obese (≥ 30.0) | 37 (44%) | 30 (35%) | |
Comorbidity (Mean, SD) | 3.34 (2.82) | 2.61 (2.54) | t value: 1.78 p = 0.0764 |
Smoking | |||
• Yes | 9 (11%) | 16 (19%) | χ2: 2.29 |
• No | 76(89%) | 69 (81%) | p = 0.1295 |
Hand Dominance | |||
• Right | 78 (92%) | 77 (91%) | Exact Fisher's: 0.10 |
• Left | 7 (8%) | 7 (8%) | p = 1.00 |
• Bilateral | None | 1 (1%) | |
Affected Side | |||
• Right | 48 (57%) | 42 (49%) | χ2: 4.90 |
• Left | 14 (16%) | 26 (31%) | p = 0.086 |
• Bilateral | 23 (27%) | 17 (20%) | |
Side operated on | |||
• Right | 61 (72%) | 50 (59%) | χ2: 3.14 |
• Left | 24 (41%) | 35 (41%) | p = 0.076 |
Symptom duration in months (Mean, SD) | 45.06(71) | 47.98 (60) | t value: -0.29 p = 0.77 |
Symptoms characteristics | |||
• Pain on movement | 66 (78%) | 67(79%) | χ2: 0.0345, p = 0.85 |
• Night pain | 59 (69%) | 51(60%) | χ2: 0.0, p = 1.00 |
• Weakness | 57 (67%) | 56 (66%) | χ2: 0.0, p = 1.00 |
• Catching/Clicking/Grinding | 40 (47%) | 40 (47%) | χ2: 0.0, p = 1.00 |
Extent of bony pathology | |||
• AC joint arthritis
|
55(65%)
|
67(74%)
|
χ
2
: 4.18, p = 0.04
|
• GH Arthritis | 22(26%) | 23(27%) | χ2: 0.05, p = 0.81 |
• Superior migration of humeral head | |||
• Subacromial Spurs | 22(26%) | 23(27%) | χ2: 0.03, p = 0.86 |
• Calcified Tendinitis | 77(91%) | 78(92%) | χ2: 0.7, p = 0.87 |
• Osteolysis of end of clavicle | 5(6%) | 6(7%) | χ2: 0.09, p = 0.76 |
• Osacromiale | 0(0%) | 3(4%) | Fisher's test: 0.12, p = 0.24 |
1(1%) | 1(1%) | Fisher's test: 0.50, p = 1.00 | |
Mechanism of injury | |||
• Insidious | 29 (34%) | 23(27%) | χ2: 0.99, p = 0.31 |
• Repetitive activities | 14(17%) | 13 (15%) | χ2: 0.44, p = 0.83 |
• Fall | 15 (18%) | 10 (12%) | χ2: 1.172, p = 0.28 |
• Traumatic
|
10 (12%)
|
21 (25%)
|
χ
2
: 4.77, p = 0.03
|
Work Status (active work-related claim related to shoulder): 36/170 | 20(24%) | 16(19%) | χ2: 0.56, p = 0.45 |
Type of surgery | |||
• Rotator Cuff repair | 44 (52%) | 50 (59%) | χ2: 0.85, p = 0.35 |
• Resection of lateral Clavicle
|
49(58%)
|
63 (74%)
|
χ
2
: 5.13, p = 0.02
|
• Acromioplasty
|
77 (91%)
|
84 (99%)
|
Exact Fisher's: 0.015
p = 0.03
|
Size of full-thickness tear | |||
• Small | 2 (2%) | 2 (2%) | Exact Fisher's: 0.65 |
• Moderate | 31 (33%) | 36 (38%) | p = 0.86 |
• Large | 12 (13%) | 11 (12%) | |
Medication taken | |||
• Yes | 32 (39%) | 41(47%) | χ2: 1.94, p = 0.16 |
• No | 53 (61%) | 44(52%) | |
Participation limitation
| |||
• Low | 31 (36%) | 45 (53%) | |
• Moderate | 18 (21%) | 25 (29%) |
χ
2
: 12.36, p = 0.002
|
• High | 36(42%) | 15(18%) | |
Strength (Mean, SD)
(Elevation in scapular plane, lb)
| |||
• Affected side
|
2.89(2.89)
|
7.01 (4.76)
|
-6.03 p < 0.0001
|
• Opposite side
|
7.81(3.28)
|
13.31(5.49)
|
-7.06 p < 0.0001
|
Range of motion (Mean, SD)
| |||
Active flexion (0/180)
|
119 (42)
|
139 (39)
|
-3.23 0.001
|
Passive flexion (0/180) | 149 (29) | 156 (25) | -1.43 0.1528 |
Active abduction (0/180)
|
106 (47)
|
128 (43)
|
-2.91 0.002
|
Passive abduction (0/180) | 138 (37) | 147 (30) | -1.36 0.17 |
Active external rotation (0/90) | 46(19) | 54(35) | -1.11 0.270 |
Passive external rotation (0/90) | 56(19) | 71(25) | 0.977 0.329 |
Combined painfree range of motion (0/40)
| |||
(Mean, SD) | |||
Flexion: 10 | |||
Abduction: 10 |
19.07 (9.61)
|
23.08 (9.92)
|
-2.65 0.009
|
External Rotation: 10 | |||
Internal Rotation: 10 |
Variables | Pr <= P |
---|---|
Do you expect your surgery to help with pain relief? | 0.802 |
Do you expect your surgery to increase your painfree range of motion? |
0.023
|
Do you expect your surgery to improve your ability to carry out the normal activities of daily living? | 0.370 |
Do you expect your surgery to improve your ability to care for others? |
0.003
|
Do you expect to return to work following your surgery? |
0.006
|
Do you expect that following your surgery you will be able to participate in the leisure, sports, or recreational activities you did before your problem started? | 0.086 |
Do you expect that following your surgery the area operated upon will be back to the way it was before you began having problems there? | 0.863 |
Variables (Min/Max) | Women Mean (SD) | MEN Mean (SD) | T/Z values ** | P values | Effect Size (CI) |
---|---|---|---|---|---|
WORC Total Raw score (0/2100)
| 1368.58 | 1234.12 |
2.42
|
0.017
| 0.37 |
Higher numbers mean more disability
| (371.74) | (353.03) | (0.07–0.67) | ||
WORC Percentage (0/100)
| 34.84% | 41.22% |
-2.42
|
0.017
| 0.37 |
Higher numbers mean less disability
| (17.70) | (16.80) | (0.07–0.67) | ||
Domains of the WORC
| |||||
Symptoms (0/600) | 351.88 | 326.58 | 1.36 | 0.175 | |
(130.22) | (111.05) | ||||
Life style* (0/400) | 271.10 | 223.35 |
3.99
|
< 0.0001
| 0.58 |
(88.67) | (84) | (0.27–0.88) | |||
Work* (0/400) | 284.55 | 249.60 |
3.25
|
0.001
| 0.47 |
(71.12) | (80) | (0.16–0.77) | |||
Sports/recreational activities* (0/400) | 290.38 | 282.45 | 1.077 | 0.282 | |
(70.92) | (67.43) | ||||
Emotions (0/300) | 170.59 | 153.96 | 1.42 | 0.157 | |
Higher numbers mean more disability
| (73.23) | (79.12) | |||
ASES (0/100)
|
42.92
|
51.12
|
-2.77
|
0.0062
|
0.42
|
Higher numbers mean less disability
|
(21.28)
|
(16.99)
| (0.12–0.73) | ||
Quick
DASH (0/100)
|
55.82
|
44.87
|
3.98
|
0.0001
|
0.61
|
Higher numbers mean more disability
|
(18.77)
|
(17.10)
| (0.30–0.92) |
Univariable Analysis: Relationship Between disability and independent variables
Independent variables | DF | R-Square | F | P value |
---|---|---|---|---|
Binominal factor of man/woman
|
1
|
0.033
|
5.85
|
0.017
|
Age | 1 | 0.014 | 2.38 | 0.125 |
BMI | 2 | 0.015 | 0.26 | 0.288 |
Comorbidity | 1 | 0.0005 | 0.09 | 0.769 |
Mechanism of injury | 3 | 0.0158 | 0.75 | 0.524 |
Hand dominance | 1 | 0.0033 | 0.31 | 0.735 |
Affected side
|
2
|
0.0327
|
3.06
|
0.049
|
Side operated on | 1 | 0.0001 | 0.02 | 0.894 |
Symptoms duration | 1 | 0.0069 | 1.26 | 0.264 |
Combined painfree ROM
|
1
|
0.305
|
72.69
|
< 0.0001
|
Strength (operated side)
|
1
|
0.120
|
22.19
|
< 0.0001
|
Smoking
|
1
|
0.025
|
4.27
|
0.040
|
Concurrent Osteoarthritis (Glenohumeral arthritis/humeral head migration) | 1 | 0.001 | 0.24 | 0.627 |
Repair vs. no repair | 1 | 0.006 | 0.97 | 0.325 |
Size of full-thickness tear (Small, moderate, large) | 2 | 0.003 | 0.15 | 0.864 |
Use of medication |
1
|
0.030
|
5.16
|
0.024
|
Work status (active work-related injury)
|
1
|
0.071
|
12.91
|
0.0004
|
Participation limitation
|
2
|
0.396
|
55.19
|
< 0.0001
|
Expectations with respect to improved pain | 1 | 0.004 | 0.07 | 0.7895 |
Expectations with respect to improved ROM | 2 | 0.024 | 2.05 | 0.1326 |
Expectations with respect to improved ADL
|
2
|
0.093
|
8.46
|
0.0003
|
Expectations with respect to improved interaction and providing care
|
2
|
0.119
|
11.03
|
< 0.0001
|
Expectations with respect to return to work
|
3
|
0.142
|
6.74
|
< 0.0001
|
Expectations with respect to return to sports | 2 | 0.021 | 1.77 | 0.173 |
Expectations with respect to achieving full recovery | 2 | 0.014 | 1.18 | 0.311 |
Subgroup-Analysis
Independent Variables | R-Square Women/Men | F value Women/Men | P value Women/Men |
---|---|---|---|
Age | 0.008/0.054
| 0.70/4.80
| 0.407/0.031
|
BMI | 0.007/0.026 | 0.28/1.11 | 0.758/0.335 |
Comorbidity | 0.001/0.0002 | 0.11/0.20 | 0.740/0.652 |
Combined Painfree ROM
|
0.326/0.249
|
38.81/27.66
|
< 0.0001/< 0.0001
|
Strength (operated side)
|
0.083/0.099
|
7.56/9.18
|
0.007/0.003
|
Smoking | 0.030/0.038 | 2.55/3.30 | 0.114/0.073 |
Mechanism of injury | 0.010/0.064 | 0.22/1.44 | 0.884/0.238 |
Hand dominance | 0.007/0.007 | 0.59/0.29 | 0.445/0.746 |
Affected side | 0.043/0.024 | 1.88/1.03 | 0.159/0.363 |
Side operated on | 0.011/0.001 | 0.94/0.10 | 0.336/0.753 |
Symptoms duration | 0.007/0.001 | 0.62/0.10 | 0.424/0.754 |
Concurrent osteoarthritis | 0.030/0.010 | 2.77/0.85 | 0.099/0.359 |
Level of pathology | 0.006/0.086
| 0.97/7.82
| 0.325/0.006
|
Size of full-thickness tear | 0.024/0.005 | 0.53/0.12 | 0.594/0.886 |
Use of medication |
0.048/ 0.008 |
4.22/ 0.71 |
0.043/ 0.402 |
Work Status (work-related injury)
|
0.059/0.080
|
5.18/7.25
|
0.025/0.009
|
Participation limitation
|
0.338/0.430
|
21.02/31.07
|
< 0.0001/< 0.0001
|
Expectations with respect to improved pain | 0.001/0.060 | 0.12/2.56 | 0.726/0.083 |
Expectations with respect to improved ROM |
0.102/ 0.001 |
4.57/ 0.11 |
0.013/ 0.739 |
Expectations with respect to improved ADL |
0.227/ 0.025 |
12.05/ 0.99 |
< 0.0001/ 0.376 |
Expectations with respect to improved interaction and providing care
|
0.125/0.094
|
5.59/4.05
|
0.005/0.021
|
Expectations with respect to return to work
|
0.130/0.163
|
3.99/5.07
|
0.011/0.003
|
Expectations with respect to return to sports | 0.012/0.036 | 0.48/1.45 | 0.618/0.240 |
Expectations with respect to achieving full recovery | 0.008/0.042 | 0.36/1.79 | 0.697/0.174 |
Multivariable Analysis: Relationship between Disability and all Significant Independent Variables
Independent variables | DF | β Estimates | F value | P value |
---|---|---|---|---|
Binominal factor of sex | 1 | Female: 1.86 | 0.67 | 0.4160 |
Male: 0.00 | ||||
Participation limitation
| 2 | Low: 17.84 |
28.91
|
< 0.0001
|
Moderate: 7.93 | ||||
High: 0.00 | ||||
Combined painfree ROM
| 1 | 0.65 |
25.82
|
< 0.0001
|
Strength | 1 | 0.07 | 0.07 | 0.7945 |
Smoking | 1 | Yes: 3.09 | 0.00 | 0.9972 |
No: 0.00 | ||||
Work Status (active work-related injury) | 1 | Yes: -2.13 | 0.76 | 0.3846 |
No: 0.00 | ||||
Affected side | 2 | Bilateral:-3.80 | 2.45 | 0.0900 |
Left: 1.76 | ||||
Right: 0.00 | ||||
Medication use | 1 | Yes: -1.10 | 0.33 | 0.5673 |
No: 0.00 | ||||
Expectations with respect to improved interaction and providing care | 2 | No difficulty: 2.63 | 1.30 | 0.2746 |
Moderate expectations: -1.59 | ||||
High expectations: 0.00 | ||||
Expectations for improved ADL
| 2 | No difficulty: 16.93 |
5.80
|
0.0038
|
Moderate expectations: 2.12 | ||||
High expectations: 0.00 | ||||
Expectations with respect to return to work | 3 | Not applicable: 3.69 | 1.00 | 0.3929 |
Working: 2.64 | ||||
Light: -1.08 | ||||
Full: 0.00 | ||||
Full Model
|
17
|
R-Square: 0.63
|
14.26
|
< 0.0001
|