Understanding of sling necessity linked with increased compliance after shoulder surgery
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Patients with a greater understanding of sling necessity, as determined by an adherence questionnaire, had increased sling compliance after shoulder surgery compared with patients with a lesser understanding, results showed.
Michael G. Livesey, MD, and colleagues at the University of Maryland School of Medicine performed a prospective cohort study of 66 patients (average age of 59 years) who underwent shoulder surgery that required a sling for at least 1 month postoperatively.
Researchers assessed patient understanding for sling necessity with a medical adherence measure questionnaire, which asked each patient, ‘‘Why did you have to wear a shoulder sling?’’ Responses were quantified with the Patient Understanding Grading Scale (PUGS), with grade 1 corresponding to the least technical knowledge of sling necessity and grade 3 corresponding to the most technical knowledge. Researchers measured sling wear with a temperature-sensing device. They also factored patient characteristics, social deprivation and home assistance into their analysis, according to the study.
Overall, patients with PUGS grade 1 wore the sling for 61.2 hours per week; patients with PUGS grade 2 wore the sling for 111.5 hours per week; and patients with PUGS grade 3 wore the sling for 120.2 hours per week. Researchers found patients who were older than 60 years of age were associated with increased sling compliance, while male patients and patients with high BMIs were associated with decreased sling compliance. They also noted patients with home assistance had “significantly greater” average weekly total hours of sling compliance (112.1 hours) compared with patients without home assistance (70.2 hours). Social deprivation had no effect on sling compliance, they noted.
“Patient adherence to physician protocols is an integral component of patient care and has been shown to improve functional outcomes after shoulder surgery,” the researchers wrote in the study.
Perspective
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The human touch of patient education is an underappreciated factor in orthopedics. This study demonstrates that patients who understand why they are wearing their sling will be more likely to wear it. The lack of understanding cuts across social and economic levels. Also, not surprisingly, younger patients tended to wear the sling less often when compared with older patients.
Several important takeaways from this article are:
- Do not assume medical literacy based on socioeconomic status;
- Younger patients need more education or different strategies to teach the importance of wearing slings;
- Patient compliance is improved when patients understand the “why” of the treatment plan.
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