Emotional ‘Grit’ Related to Function After Rotator Cuff Surgery

SAN DIEGO — A recent study suggests patients who have low “grit” may have worse functional outcome following rotator cuff surgery. Researchers from the University of North Carolina presented data on 126 patients undergoing rotator cuff repair (RCR) correlating a patient’s level of grit with functional outcomes following surgery.

The term “grit” recently was popularized with the 2016 publication of the book  Grit: The Power of Passion and Perseverance  by Angela Duckworth. Grit is defined as the ability to persevere and maintain a passion for long-term goals

Duckworth, a psychologist and and popular-science author, introduced readers to her work on the Grit Scale, a validated twelve-question measure that has been shown to correlate with achievement.

“There has been increasing evidence of the role psychosocial factors play in patient outcomes following orthopedic procedures,” Kurt Stoll, MD, lead author on the paper, told Medscape Medical News. “Given this, as well as the developing interest in grit secondary to Dr Duckworth’s book, we decided to see if grit was associated with outcomes following rotator cuff repair.”

Patients in the RCR study, presented at the 2021 American Academy of Orthopaedic Surgeons Annual Meeting, were provided a single survey that included the Short Grit Scale, an American Shoulder and Elbow (ASES) Score questionnaire, Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) questions, and a pain analog scale.

The mean grit score obtained from the study was 4.0 (range 2.2–5.0). Multivariate analysis showed that grit scores were independently correlated with ASES scores (Beta = 6.7, P = .04), PROMIS-UE scores (Beta = 6.5, P = .0003), and pain analog scores (Beta = -0.7, P = .05).

According to the study authors, grit accounted for 18% of the variance seen in patient reported outcomes.

“Although you may not examine grit in every patient, it is important to consider a patient’s psychosocial health when determining a treatment plan,” Stoll told Medscape Medical News. “The difficulty at this point is finding the best measures of psychosocial health that are easy to use and provide prognostic information that can be conveyed to the surgeon and patient.”

Paul Cagle, MD, an orthopedic surgeon from Mount Sinai Hospital in New York City who was not involved in the study, commented, “I am highly familiar with the term ‘grit’ and I believe the term holds real importance. This is a term we often use to discuss surgical residency and success.”

At this point, he doesn’t believe the research has reached a level where he would consider screening a patient before surgery, but he thinks the study highlights an important aspect of patient recovery. 

“Although this understanding is at an early stage, this is a field where additional research will help clinicians better prepare their patients,” Cagle said. “I don’t see this paper creating a major overall change to a practice, but it should provide each of us pause to remember there are many factors to consider when caring for patients.”

And he added: “I am unsure if this is something that can be improved before an operation.”

Asked if he had any concerns about introducing a popular science term into the orthopedic literature, Cagle replied, “As long as the science is done with logic and rigor, I do not have any opposition.”

Stoll and Cagle have disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2021 Annual Meeting: Program 164. Presented August 31, 2021.

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