Psychological Well-being and Physical Activity Before and After Rotator Cuff Repair: A Scoping Review

Background In patients with rotator cuff (RC) pathology, poor psychological well-being, such as depression and anxiety symptoms and kinesiophobia, have reported an association with worse shoulder symptoms, function, pain, and/or quality-of-life (QoL). Individuals with kinesiophobia often avoid certain activities, which may lead to muscle weakness, decreased range of motion, low physical activity (PA), and/or decreased function. This scoping review aimed to explore and summarize the current evidence regarding psychological factors and PA levels in patients with RC pathology before and after repair surgery. Methods We searched PubMed, Embase, Scopus, SPORTDiscus, and PsycINFO databases for relevant studies. We included studies that enrolled patients with RC pathology undergoing repair surgery and reported psychological well-being and/or PA measures before and after surgery. We summarized the study characteristics and findings, including the study design, sample size, demographics, and measures of psychological well-being and/or PA before and after RC repair. Lastly, descriptive consolidation and qualitative synthesis were performed for the included studies. Results Out of 11,026 potential studies, 13 studies met our criteria and were included. Of the studies included, 3 were retrospective and 10 were prospective studies, and all of them were published in 2015 and later. Among the included studies, depression symptoms (n=10), anxiety symptoms (n=7), kinesiophobia (n=2), and negative thoughts (n=2) were reported as psychological factors that negatively influence the symptoms and recovery patients with RC pathology before and after surgical repair. Importantly, none of the included studies examined PA measures in patients with RC pathology before and after RC repair. Conclusion In patients with RC pathology, depression and anxiety symptoms have been commonly-examined before and after RC repair. Worse depression and anxiety symptoms were reported to be associated with worse pain, reduced function, and lower QoL. Consideration of PA in the screening and rehabilitation before and after RC repair was identified as a substantial gap in literature. Future research is encouraged to explore how the interplay between PA and psychological factors influences treatment outcomes for RC pathology, which may guide more holistic and effective rehabilitation strategies.