Abstract
BACKGROUND: In recent years, the prevalence of shoulder arthroplasty and arthroscopic rotator cuff repairs has increased. Patients with stable mental health have exhibited better outcomes following shoulder surgery. Resilience is a psychosocial trait defined as the ability to positively adapt in the face of challenging situations, which can be modifiable. The purpose of this study was to perform a systematic review to determine whether resilience is predictive of clinical outcome measures following shoulder surgery. MATERIALS AND METHODS: We performed a systematic review of literature published between January 1, 2014, and June 9, 2024. A comprehensive search of PubMed, MEDLINE, Embase, and Scopus was performed. Nine studies met the inclusion criteria after screening for all studies. A quality assessment was performed using the Methodological Index for Nonrandomized Studies tool. Data extracted included level of evidence, Methodological Index for Nonrandomized Studies score, age, body mass index-, sex, cohort size, final cohort size, mean follow-up, prior surgery(s), preoperative diagnosis, presence of mental health condition, preoperative resilience scores, postoperative resilience scores, resilience stratification groups, preoperative functional outcome scores, postoperative functional outcome scores, preoperative PROM (patient-reported outcome measure) scores, postoperative PROM scores, and complications. RESULTS: Six studies assessed resilience with rotator cuff repair, and 3 studies focused on shoulder arthroplasty. The final cohort included 1,154 patients with a mean age of 61.6 years. Three different resilience scales were used in the study, including the Brief Resilience Scale, Connor-Davidson Resilience Score, and the Life Orientation Test-Revised. Resilience was noted to have a significant effect on outcomes based on American Shoulder and Elbow Surgeons scores, Penn Shoulder Score, Patient-Reported Outcomes Measurement Information System Global Health 10 score, and Simple Shoulder Test. There was a low rate of significance between resilience and the Single Assessment Numeric Evaluation score and the Visual Analog Scale (VAS) for pain. DISCUSSION: Resilience has been shown to correlate with clinical outcome measures following shoulder surgery; however, there is relative inconsistency regarding which clinical outcome measures demonstrate a significant effect on. The relationship between resilience and outcomes following shoulder surgery needs to be further evaluated.