Rotator cuff tears (RCTs) can be caused by injury (e.g. by playing sports) or by deterioration of the rotator cuff as a person gets older. Currently in the United Kingdom (UK), patients with an RCT are kept comfortable with painkillers from their doctor and physiotherapy sessions. But if the pain cannot be managed and symptoms worsen, the patient may have surgery in hospital to repair their rotator cuff. At present, there are few studies which investigate the type of people who experience RCTs in England and their treatment journey from the time when they were first diagnosed. It is also not clear whether how long a patient waits for their operation in hospital from first being diagnosed; how this impacts their long-term recovery from the injury, and how a longer wait time, for example, may impact the healthcare service in England.
This study aims to select patients with RCT and describe their treatments, including surgery, if applicable. The study will also investigate the associated impact on the healthcare service in England with regards to resources and costs of treating these patients. Furthermore, the study will look in more detail at the patients who undergo surgery and report their waiting time from diagnosis to surgery to see if there is a relationship between the length of time they wait, and the level of impact on the patient and healthcare service in England. Understanding these issues will allow better treatment pathways in future, thereby improving public health.
Rotator cuff tears (RCTs) can result from injury or shoulder degeneration and cause loss of motion or pain in the shoulder. In the UK, RCT is initially managed in primary care using pain relief treatments and physiotherapy. When symptoms persist, patients may be referred to secondary care for assessment and possible surgery. There is a paucity of UK real-world information on the RCT patient population, treatment, referral pathway and associated healthcare resource use (HCRU). There is also uncertainty as to whether the waiting time from RCT diagnosis to surgery is associated with patient outcomes and HCRU.
The primary study aim is to estimate the incidence of RCT in England (2015-2019) and to describe the RCT population. Description will be using summary statistics in all RCT patients, and also separately in those who undergo / do not undergo RCT surgery. Demographics, smoking, index of multiple deprivation, body mass index (BMI), Charlson Comorbidity Index (CCI), and specific RCT-related co-morbidities as well as newly prescribed pain treatments post-RCT diagnosis (analgesics, corticosteroid injection as a longitudinal list) will be obtained from CPRD and / or HES. The volume of healthcare resource use (HCRU) 12-months prior and 12-months post-RCT diagnosis will be described and costed, including primary care visits (general practitioner [GP] / nurse / other allied healthcare professionals) on CPRD, and secondary care on HES (outpatient, overall, and specifically at trauma and orthopaedics / physiotherapy departments; day case and elective inpatient admission for rotator-cuff repair). A second aim is to further describe time to surgery, outcomes, and HCRU and costs in patients who undergo RCT surgery. The association between waiting time and post-surgery HCRU will be modelled using linear regression adjusting for potential confounders. Analyses will be completed overall and separately in < and >65 years old patients at RCT diagnosis.
Age; sex; index of multiple deprivation; smoking; CCI; BMI; RCT-specific co-morbidities (osteoporosis, obesity, diabetes, hypertension, hypercholesterolemia); surgery for rotator-cuff repair, rotator-cuff retear, revision surgery for RCT; pain medications; corticosteroid injection; healthcare resource use (primary care visits for RCT; secondary care outpatient overall and at trauma and orthopaedics / physiotherapy departments; day case and elective inpatient admission for rotator-cuff repair; physiotherapy visits for RCT) and associated costs for each HCRU category.
- Chief Investigator -
Ellen Hubbuck - Corresponding Applicant - Pharmatelligence Limited t/a Human Data Sciences
- Collaborator -
David Heaton - Collaborator - Harvey Walsh Ltd
Leo Nherera - Collaborator - T.J.Smith and Nephew, Limited
Matthew O'Connell - Collaborator - Harvey Walsh Ltd
Neil Cameron Hatrick - Collaborator - University Hospitals Sussex NHS Foundation Trust
Paul Trueman - Collaborator - T.J.Smith and Nephew, Limited
Richard Searle - Collaborator - T.J.Smith and Nephew, Limited
Sue Beecroft - Collaborator - Harvey Walsh Ltd
Myriam Alexander - Collaborator - Harvey Walsh Ltd
Myriam Alexander - Collaborator - OPEN VIE
Sue Beecroft - Collaborator - Harvey Walsh Ltd
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;Patient Level Index of Multiple Deprivation