2025 Neer Award Part 2: The PMADS Trial: Personality, Motivation, and Attitude Determinants of Success with Rehabilitation for Reverse Total Shoulder Arthroplasty.

Abstract

A subset of patients from "Part 1 - The SHORT Trial: Multicenter, Randomized, Controlled Trial of Surgeon-Directed Home Therapy vs. Outpatient Rehabilitation by Physical Therapists for Reverse Total Shoulder Arthroplasty" were analyzed for various personality, psychological, and health motivation scores to elucidate if these characteristics might influence success with either clinic-based physical therapy (PT) or surgeon-directed home therapy (HT). Three of the original centers from the SHORT trial participated with the same patients and inclusion/exclusion criteria. Surveys designed to capture psychological traits, motivation, and gauge comprehensive patient health were administered to assess for moderating effects on American Shoulder and Elbow Surgeons (ASES) score, pain intensity score, Single Assessment Numeric Evaluation (SANE), and complications for both PT and HT groups. 89 patients across three sites were included for analysis. Moderator analysis demonstrated no association between the Short GRIT Scale (GRIT-S) (p=0.54, p=0.48, p=0.51, p=0.61), the Short Health Anxiety Inventory (SHAI) (p=0.34, p=0.97, p=0.37, p=0.71), the Motivations and Attitudes Towards Changing Health (MATCH) score (p=0.24, p=0.41, p=0.21, p=0.95), the Shoulder Activity Scale (p=0.97, p=0.42, p=0.08, p=0.66), the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag assessment tool (OSPRO-YF) negative mood (p=0.41, p=0.95, p=0.33, p=0.87), OSPRO-YF fear (p=0.38, p=0.30, p=0.75, p=0.37), OSPRO-YF coping (p=0.50, p=0.77, p=0.75, p=0.45) on ASES scores, pain intensity scores, SANE scores and complications respectively at final 2-year follow-up. No personality, attitude, grit, psychological, or motivational characteristics were found to be associated with success or failure with surgeon-directed home therapy.