Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
The social determinants of health (SDOH) are factors outside of medical that affect health outcomes. This article evaluates the effects of SDOH on rotator cuff repair with the intention to provide more information to health care providers so they can assist their patients in making more informed decisions.
Methods
Articles for this systematic review were collected by two independent investigators. Articles included randomized and non-randomized studies that focused on rotator cuff repairs, outcomes, and SDOH. Reviewers evaluated articles by evidence level and quality.
Results
Out of 842 articles, 14 were included in the analysis. Seven articles assessed the effects of SDOH on rotator cuff repair and seven evaluated effects of SDOH on outcomes following rotator cuff repair. Based on studies assessing the effect of race/ethnicity on surgical utilization and post-op outcomes, those who were identified as non-white were associated with lower surgical rates and PT treatment. Black patients were also more likely to have worse outcomes using patient reported outcome measures at long-term follow-up. Other studies determined that patients with public insurance, Medicaid, or Medicare were more likely to have a longer wait to first PT follow-up, less PT utilization, and decreased acceptance for post-op PT. Although higher education was related to better post-op satisfaction, there was no difference in Shoulder Pain and Disability Index scores.
Discussion
This systematic review revealed that non-White patients are less likely to receive surgical intervention and less likely to utilize physical therapy. Additionally, those of lower socioeconomic status are more likely to have a longer wait for their first PT appointment due to several factors, including less PT clinics accepting their insurance. It is important to understand SDOH effects on health outcomes because they lead to many disparities within society. Continuing to study these factors can help health care providers determine how to decrease the gap in healthcare disparities.
Conclusion
Race and insurance type can influence patient treatment and outcomes following a rotator cuff repair. It is important that this topic continues to be studied and health care providers, specifically orthopedic surgeons, understand patient external factors.
Paul, R.W., Osman, A., Nigro, A., Muchintala, R., Destine, H., Tjoumakaris, F.P, & Freedman, K.B. (2024). The effects of social determinants of health on rotator cuff repair utilization and outcomes: a systematic review. JSES Reviews, Reports, and Techniques, 4(2024), 346-352. https://doi.org/10.1016/j.xrrt.2024.03.015.