title: Resilience correlates with outcomes after total shoulder arthroplasty.
abstract: BACKGROUND
  Resilience, characterized by an ability to bounce back or recover from stress, is increasingly recognized as a psychometric property affecting many outcomes' domains including quality of life, suicide risk in active-duty military personnel, and recovery in cancer patients. This study examines the correlation between resilience, as measured by the Brief Resilience Scale (BRS), and traditional outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn scores in patients undergoing total shoulder arthroplasty (TSA).
  
  
  METHODS
  Seventy patients undergoing primary anatomic TSA were followed up for a minimum of 2 years (mean, 30 ± 3 months). Patients were stratified into groups a priori, based on deviation from the mean of the BRS score, into low-resilience (LR), normal-resilience (NR), and high-resilience (HR) patients, and outcome scores were calculated for each group.
  
  
  RESULTS
  Postoperative BRS scores significantly correlated with ASES, Penn, and SANE scores (r = 0.41-0.44, P < .004 for all scores). When we evaluated patients based on resilience group, the LR group had a Penn score that was 34 points lower than that in the HR group. Likewise, the LR group had a SANE score that averaged 40 points lower than that in the HR group (SANE score of 53 points in LR group and 92 points in HR group, P = .05). When we evaluated ASES subscores, it appeared that the pain subscale was responsible for most of the difference between the LR and HR groups (29 points and 48 points [out of 50 points], respectively; P = .03).
  
  
  CONCLUSIONS
  Resilience is a major predictor of postoperative outcomes after TSA. Patients who are classified as having LR have outcome scores that are 30 to 40 points lower on traditional outcome scales than patients with HR.
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA. Electronic address: jtokish@ghs.org.
authors.forename: John M
authors.initials: JM
authors.lastname: Tokish
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kissenberth
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA.
authors.forename: Stefan J
authors.initials: SJ
authors.lastname: Tolan
authors.affiliation: School of Medicine, University of South Carolina-Greenville, Greenville, SC, USA.
authors.forename: Tariq I
authors.initials: TI
authors.lastname: Salim
authors.affiliation: School of Medicine, University of South Carolina-Greenville, Greenville, SC, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Tadlock
authors.affiliation: School of Medicine, University of South Carolina-Greenville, Greenville, SC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kellam
authors.affiliation: Hawkins Foundation, Greenville, SC, USA.
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Long
authors.affiliation: Hawkins Foundation, Greenville, SC, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Crawford
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA.
authors.forename: Keith T
authors.initials: KT
authors.lastname: Lonergan
authors.affiliation: Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hawkins
authors.affiliation: ATI Physical Therapy, Greenville, SC, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Shanley
mesh_terms: D000328:Adult; D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D055500:Resilience, Psychological; D012189:Retrospective Studies; D012785:Shoulder Joint; D016896:Treatment Outcome
keywords: Total shoulder arthroplasty; osteoarthritis; outcomes; psychometrics; quality of life; resilience