title: Greater patient confidence yields greater functional outcomes after primary total shoulder arthroplasty.
abstract: BACKGROUND
  Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores.
  
  
  METHODS
  Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass index, baseline 12-Item Short Form Health Survey mental component scores, college education, smoking status, baseline functional scores, and length of follow-up.
  
  
  RESULTS
  Patients had a high level of confidence that their outcome would match their expectations, with an average score of 7.8 (range, 0-10; 28.4% reported a full 10/10 confidence). For every 1-point increase in confidence, patients experienced an average increase in their function score of 2.7 points (P = .039) and improvement in their pain score of 2.0 (P = .033) according to the Penn Shoulder Score. There was no significant association with the patient's 12-Item Short Form Health Survey score postoperatively.
  
  
  CONCLUSIONS
  Patients with greater preoperative confidence actually have significantly better postoperative functional outcomes than their less confident peers even with adjustment for other known risk factors.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address: styronj@ccf.org.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Styron
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Higuera
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Strnad
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Iannotti
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000523:psychology / Q000601:surgery*; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Confidence; function; joint arthroplasty; outcomes; predictors; total shoulder replacement