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Baltassat A, Riffault L, Villatte G, Meyer N, Antoni M, Clavert P. History of mood and anxiety disorders affects return to work and return to sports after rotator cuff repair. Orthop Traumatol Surg Res 2024:103854. [PMID: 38432470 DOI: 10.1016/j.otsr.2024.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors - mood and anxiety disorders (MAD) - is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD. MATERIALS AND METHODS This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the "working" and "sports" groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis. RESULTS The "working" group consisted of 158 patients (of which 16.5% had MAD) and the "sports" group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21±11 weeks later and the return to sports was 17±8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR=2.8 [1; 7.8]). CONCLUSION We found a negative influence of prior MAD on the return to work and return to sports after RCR. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Antoine Baltassat
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Louis Riffault
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Guillaume Villatte
- Service de chirurgie orthopédique et traumatologique, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France; Pole de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
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Huddleston HP, Mehta N, Lavoie-Gagne OZ, Maheshwer B, Fu MC, Cole BJ, Verma NN, Forsythe B, Yanke AB. Patient-reported outcomes measurement information system depression psychometrically underperforms compared to legacy measures and is poorly associated with postoperative functional outcomes in shoulder arthroplasty patients. Shoulder Elbow 2023; 15:626-633. [PMID: 37981972 PMCID: PMC10656966 DOI: 10.1177/17585732221137555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2023]
Abstract
Background The purpose of this study was to investigate the associations between each mental health patient-reported outcome measure with postoperative functional outcomes following shoulder arthroplasty, and to compare psychometric properties of patient-reported outcomes measurement information system depression to the legacy (VR-12 Mental) patient-reported outcome measure. Methods Patients who underwent primary shoulder arthroplasty from July 2018 to February 2019 were retrospectively reviewed. Patient-reported outcomes measurement information system depression and VR-12 Mental were administered preoperatively; American Shoulder and Elbow Surgeons and Single Assessment Numeric Evaluation were administered at 6-month and 1-year postoperatively. Rasch partial credit modeling analysis was used to compare psychometric properties of legacy versus patient-reported outcomes measurement information system instruments in assessing mental health. Results Ninety-three patients who underwent total shoulder arthroplasty (n = 52), reverse total shoulder arthroplasty (n = 39), or hemiarthroplasty (n = 2) were included. Preoperative VR-12 Mental scores were moderately associated with American Shoulder and Elbow Surgeons at 6-months (coefficient: 0.52, P = 0.026) and 1-year (coefficient: 0.65, P = 0.002), while preoperative patient-reported outcomes measurement information system depression scores were not. Patient-reported outcomes measurement information system depression demonstrated significant floor effects (16%); VR-12 Mental demonstrated minimal floor and ceiling effects (1.1% for both). VR-12 Mental demonstrated broader coverage of mental outlook on Rasch modeling than patient-reported outcomes measurement information system depression and had adequate model fit after one round of reiterative item elimination. Discussion Patient-reported outcomes measurement information system depression was poorly associated with postoperative American Shoulder and Elbow Surgeons scores, demonstrated significant floor effects, and had limited coverage of mental health on Rasch modeling with reiterative elimination. Level of Evidence IV.
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Affiliation(s)
| | - Nabil Mehta
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | | | - Bhargavi Maheshwer
- Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | | | - Brian J Cole
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Adam B Yanke
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
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Dujeux C, Antoni M, Thery C, Eichler D, Meyer N, Clavert P. History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair. Orthop Traumatol Surg Res 2023; 109:103550. [PMID: 36642405 DOI: 10.1016/j.otsr.2023.103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. AIM OF STUDY AND HYPOTHESIS The primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. MATERIALS AND METHODS The study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). RESULTS The Constant score was lower preoperatively in patients with history of MAD (-4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). DISCUSSION/CONCLUSION Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Clément Dujeux
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Charles Thery
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - David Eichler
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France; Pôle de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
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Okafor C, Levin J, Boadi P, Cook C, George S, Klifto C, Anakwenze O. Pain Associated Psychological Distress is More Strongly Associated with Shoulder Pain and Function than Tear Severity in Patients Undergoing Rotator Cuff Repair. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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Perioperative Management in Shoulder Arthroplasty: A Review of Current Practice. Orthop Clin North Am 2022; 53:483-490. [PMID: 36208890 DOI: 10.1016/j.ocl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Perioperative management for patients undergoing shoulder arthroplasty has evolved significantly over the years to reduce overt complications and improve patient outcomes. The groundwork for perioperative care encompasses initial patient selection and education strategies for achieving successful outcome. Multimodal pain management strategies have advanced patient care with the increased use of new regional/local anesthetics. In addition, complications resulting from blood loss and transfusions have been curtailed with the use of synthetic antifibrinolytic agents. It remains critical for shoulder arthroplasty surgeons to optimize patients during the perioperative period through various modalities to maximize functional progression, outcomes, and patient's satisfaction following shoulder arthroplasty.
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Brindisino F, Silvestri E, Gallo C, Venturin D, Di Giacomo G, Peebles AM, Provencher MT, Innocenti T. Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1219-e1234. [PMID: 35747628 PMCID: PMC9210488 DOI: 10.1016/j.asmr.2022.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS). Methods Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (≥ 30 < 70 years old) with FSCS. Results Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline. Conclusion Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | | | | | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | | | - Matthew T Provencher
- Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.,GIMBE Foundation, Bologna, Italy
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Janela D, Costa F, Molinos M, Moulder RG, Lains J, Francisco GE, Bento V, Cohen SP, Correia FD. Asynchronous and Tailored Digital Rehabilitation of Chronic Shoulder Pain: A Prospective Longitudinal Cohort Study. J Pain Res 2022; 15:53-66. [PMID: 35035234 PMCID: PMC8755939 DOI: 10.2147/jpr.s343308] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic shoulder pain (SP) is responsible for significant morbidity, decreased quality of life and impaired work ability, resulting in high socioeconomic burden. Successful SP management is dependent on adherence and compliance with effective evidence-based interventions. Digital solutions may improve accessibility to such treatments, increasing convenience, while reducing healthcare-related costs. Purpose Present the results of a fully remote digital care program (DCP) for chronic SP. Patients and Methods Interventional, single-arm, cohort study of individuals with chronic SP applying for a digital care program. Primary outcome was the mean change between baseline and 12 weeks on the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were change in pain (NPRS), analgesic consumption, intention to undergo surgery, anxiety (GAD-7), depression (PHQ-9), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement. Results From 296 patients at program start, 234 (79.1%) completed the intervention. Changes in QuickDASH between baseline and end-of-program were both statistically (p < 0.001) and clinically significant, with a mean reduction of 51.6% (mean −13.45 points, 95% CI: 11.99; 14.92). Marked reductions were also observed in all secondary outcomes: 54.8% in NPRS, 44.1% ceased analgesics consumption, 55.5% in surgery intent, 37.7% in FABQ-PA, 50.3% in anxiety, 63.6% in depression and 66.5% in WPAI overall. Higher engagement was associated with higher improvements in disability. Mean patient satisfaction score was 8.7/10.0 (SD 1.6). Conclusion This is the first real-world cohort study reporting the results of a multimodal remote digital approach for chronic SP rehabilitation. High completion and engagement rates were observed, which were associated with clinically significant improvement in all health-related outcomes, as well as marked productivity recovery. These promising results support the potential of digital modalities to address the global burden of chronic musculoskeletal pain.
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Affiliation(s)
- Dora Janela
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Fabíola Costa
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Maria Molinos
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center McGovern Medical School, and TIRR Memorial Hermann, Houston, TX, USA
| | - Virgílio Bento
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- SWORD Health Technologies, Inc, Clinical Validation, Draper, UT, USA.,Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Panattoni N, Longo UG, De Salvatore S, Castaneda NSC, Risi Ambrogioni L, Piredda M, De Marinis MG, Denaro V. The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre- and post-surgery: a systematic review. Qual Life Res 2021; 31:91-116. [PMID: 34216351 DOI: 10.1007/s11136-021-02921-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Recent research shows that major levels of psychological distress correlate with higher pain and reduced function in patients with shoulder and rotator cuff pathology. A systematic review updating a review published in 2016 was conducted to determine the degree of consistency and the strength of association between psychosocial factors and patient-reported outcomes (PROMs) in patients with rotator cuff repair (RCR) with new high-quality literature. METHODS The bibliographic searches were conducted from May to June 2020 within the following databases: MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science. The articles included should discuss the association between psychosocial factors and outcomes in patients with documented or diagnosed rotator cuff tears through clinical and/or radiological examination. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the methodological quality. RESULTS Fifteen articles were included. Negative psychosocial factors were found consistently associated with worse function and disability in the pre- and post-operative period. In particular, psychosocial factors regarding emotional or mental health were associated with a weak to a substantial degree with preoperative and postoperative function/disability and pain intensity in patients undergoing RCR. CONCLUSION In patients undergoing repair of the rotator cuff tear, there was a correlation between poor psychological function before surgery and worsening post-surgical outcomes, such as persistence of postoperative pain intensity and worse levels of function/disability.
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Affiliation(s)
- Nicolò Panattoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy
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9
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Agarwalla A, Lu Y, Chang E, Patel BH, Cancienne JM, Cole BJ, Verma N, Forsythe B. Influence of mental health on postoperative outcomes in patients following biceps tenodesis. J Shoulder Elbow Surg 2020; 29:2248-2256. [PMID: 32684282 DOI: 10.1016/j.jse.2020.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the relationship between preoperative mental health measured by the Short-Form 12 health survey mental component score and outcomes after isolated biceps tenodesis. METHODS The American Shoulder and Elbow Surgeons form (ASES), Single Assessment Numeric Evaluation (SANE), Constant-Murley score (CMS), and visual analog scale (VAS) for pain were administered preoperatively and at 6 and 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018. Minimal clinically important difference, substantial clinical benefit (SCB), patient-acceptable symptom state (PASS), and rates of achievement were calculated. Patients were stratified by mental health status based on preoperative scores on the Short-Form 12 health survey mental component score. Multivariate logistic regression was performed to evaluate preoperative mental health status on achievement of minimal clinically important difference, SCB, and PASS. RESULTS Patients demonstrated significant improvements in all outcome measures (P < .001). Patients with depression reported inferior postoperative scores on all patient-reported outcome measures. Low preoperative mental health score significantly predicted reduced likelihood to achieve SCB (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.17-0.81, P = .01) and PASS (OR: 0.28, 95% CI: 0.12-0.65, P = .003) on the ASES form, SANE (OR: 0.24, 95% CI: 0.10-0.61, P = .003), CMS (OR: 0.25, 95% CI: 0.08-0.77, P = .016), and VAS pain (OR: 0.01, 95% CI: 0.00-0.31, P = .008). CONCLUSION Patients with depression reported inferior scores on all postoperative patient-reported outcome measures and demonstrated lower odds of achieving the SCB and PASS on the ASES form and PASS on the SANE, CMS, and VAS pain, compared with nondepressed patients.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Chang
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | | | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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10
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Champagne R, Bodin J, Fouquet N, Roquelaure Y, Petit A. Functional incapacity related to rotator cuff syndrome in workers. Is it influenced by social characteristics and medical management? J Hand Ther 2020; 32:322-327. [PMID: 29217292 DOI: 10.1016/j.jht.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Survey. INTRODUCTION Rotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management. PURPOSE OF THE STUDY The purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care. METHODS A cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months. RESULTS Two hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6). DISCUSSION The demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS. CONCLUSION The sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients.
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Affiliation(s)
- Romain Champagne
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France
| | - Julie Bodin
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France
| | - Natacha Fouquet
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Santé publique France, French National Public Health Agency, Direction of Occupational Health, Saint Maurice, France
| | - Yves Roquelaure
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Department of Occupational health, University Hospital of Angers, Angers, France
| | - Audrey Petit
- INSERM, U1085, IRSET, ESTER Team, University of Angers, Angers, France; Department of Occupational health, University Hospital of Angers, Angers, France.
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11
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MacDermid JC, Valdes K, Szekeres M, Naughton N, Algar L. The assessment of psychological factors on upper extremity disability: A scoping review. J Hand Ther 2019; 31:511-523. [PMID: 29198477 DOI: 10.1016/j.jht.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/17/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury. METHODS Twenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity. RESULTS Twenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs. DISCUSSION The majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient's characteristics and diagnoses. CONCLUSIONS The nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.
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Affiliation(s)
- Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
| | - Kristin Valdes
- Occupational Therapy Department, Gannon University, Ruskin, FL, USA
| | | | | | - Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
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12
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Klein JS, Davis DE, Wells ZS, Kane LT, Sholder D, Namdari S, Abboud JA. The Distress and Risk Assessment Method predicts postoperative narcotic use in patients undergoing rotator cuff repair. J Shoulder Elbow Surg 2019; 28:S146-S153. [PMID: 31196509 DOI: 10.1016/j.jse.2019.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR). PURPOSE As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR. MATERIALS AND METHODS This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents. RESULTS Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for "at risk or depressed." This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake (P = .004). CONCLUSION Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.
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Affiliation(s)
- Jason S Klein
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Daniel E Davis
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zach S Wells
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Liam T Kane
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel Sholder
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Alokozai A, Eppler SL, Lu LY, Sheikholeslami N, Kamal RN. Can Patients Forecast Their Postoperative Disability and Pain? Clin Orthop Relat Res 2019; 477:635-643. [PMID: 30762696 PMCID: PMC6382205 DOI: 10.1097/corr.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Forecasting is a construct in which experiences and beliefs inform a projection of future outcomes. Current efforts to predict postoperative patient-reported outcome measures such as risk-stratifying models, focus on studying patient, surgeon, or facility variables without considering the mindset of the patient. There is no evidence assessing the association of a patient's forecasted postoperative disability with realized postoperative disability. Patient-forecasted disability could potentially be used as a tool to predict postoperative disability. QUESTIONS/PURPOSES (1) Do patient-forecasted disability and pain correlate with patient-realized disability and pain after hand surgery? (2) What other factors are associated with patient ability to forecast disability and pain? METHODS We completed a prospective, longitudinal study to assess the association between forecasted and realized postoperative pain and disability as a predictive tool. One hundred eighteen patients of one hand/upper extremity surgeon were recruited from November 2016 to February 2018. Inclusion criteria for the study were patients undergoing hand or upper extremity surgery, older than 18 years of age, and English fluency and literacy. We enrolled 118 patients; 32 patients (27%) dropped out as a result of incomplete postoperative questionnaires. The total number of patients eligible was not tracked. Eighty-six patients completed the preoperative and postoperative questionnaires. Exclusion criteria included patients unable to give informed consent, children, patients with dementia, and nonEnglish speakers. Before surgery, patients completed a questionnaire that asked them to forecast their upper extremity disability (DASH [the shortened Disabilities of the Arm, Shoulder and Hand] [QuickDASH]) and pain VAS (pain from 0 to 10) for 2 weeks after their procedure. The questionnaire also queried the following psychologic factors as explanatory variables, in addition to other demographic and socioeconomic variables: the General Self Efficacy Scale, the Pain Catastrophizing Scale, and the Patient Health Questionnaire Depression Scale. At the 2-week followup appointment, patients completed the QuickDASH and pain VAS to assess their realized disability and pain scores. Bivariate analysis was used to test the association of forecasted and realized disability and pain reporting Pearson correlation coefficients. Unpaired t-tests were performed to test the association of demographic variables (for example, men vs women) and the association of forecasted and realized disability and pain levels. One-way analysis of variance was used for variables with multiple groups (for example, annual salary and ethnicity). All p values < 0.05 were considered statistically significant. RESULTS Forecasted postoperative disability was moderately correlated with realized postoperative disability (r = 0.59; p < 0.001). Forecasted pain was weakly correlated with realized postoperative pain (r = 0.28; p = 0.011). A total of 47% of patients (n = 40) were able to predict their disability score within the MCID of their realized disability score. Symptoms of depression also correlated with increased realized postoperative disability (r = 0.37; p < 0.001) and increased realized postoperative pain (r = 0.42; p < 0.001). Catastrophic thinking was correlated with increased realized postoperative pain (r = 0.31; p = 0.004). Patients with symptoms of depression realized greater pain postoperatively than what they forecasted preoperatively (r = -0.24; p = 0.028), but there was no association between symptoms of depression and patients' ability to forecast disability (r = 0.2; p = 0.058). Patient age was associated with a patient's ability to forecast disability (r = .27; p = 0.011). Catastrophic thinking, self-efficacy, and number of prior surgical procedures were not associated with a patient's ability to forecast their postoperative disability or pain. CONCLUSIONS Patients undergoing hand surgery can moderately forecast their postoperative disability. Surgeons can use forecasted disability to identify patients who may experience greater disability compared with benchmarks, for example, forecast and experience high QuickDASH scores after surgery, and inform preoperative discussions and interventions focused on expectation management, resilience, and mindset. LEVEL OF EVIDENCE Level III, prognostic study.
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van der Windt DA, Burke DL, Babatunde O, Hattle M, McRobert C, Littlewood C, Wynne-Jones G, Chesterton L, van der Heijden GJMG, Winters JC, Rhon DI, Bennell K, Roddy E, Heneghan C, Beard D, Rees JL, Riley RD. Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis. Diagn Progn Res 2019; 3:15. [PMID: 31410370 PMCID: PMC6686538 DOI: 10.1186/s41512-019-0061-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shoulder pain is one of the most common presentations of musculoskeletal pain with a 1-month population prevalence of between 7 and 26%. The overall prognosis of shoulder pain is highly variable with 40% of patients reporting persistent pain 1 year after consulting their primary care clinician. Despite evidence for prognostic value of a range of patient and disease characteristics, it is not clear whether these factors also predict (moderate) the effect of specific treatments (such as corticosteroid injection, exercise, or surgery). OBJECTIVES This study aims to identify predictors of treatment effect (i.e. treatment moderators or effect modifiers) by investigating the association between a number of pre-defined individual-level factors and the effects of commonly used treatments on shoulder pain and disability outcomes. METHODS This will be a meta-analysis using individual participant data (IPD). Eligible trials investigating the effectiveness of advice and analgesics, corticosteroid injection, physiotherapy-led exercise, psychological interventions, and/or surgical treatment in patients with shoulder conditions will be identified from systematic reviews and an updated systematic search for trials, and risk of bias will be assessed. Authors of all eligible trials will be approached for data sharing. Outcomes measured will be shoulder pain and disability, and our previous work has identified candidate predictors. The main analysis will be conducted using hierarchical one-stage IPD meta-analysis models, examining the effect of treatment-predictor interaction on outcome for each of the candidate predictors and describing relevant subgroup effects where significant interaction effects are detected. Random effects will be used to account for clustering and heterogeneity. Sensitivity analyses will be based on (i) exclusion of trials at high risk of bias, (ii) use of restricted cubic splines to model potential non-linear associations for candidate predictors measured on a continuous scale, and (iii) the use of a two-stage IPD meta-analysis framework. DISCUSSION Our study will collate, appraise, and synthesise IPD from multiple studies to examine potential predictors of treatment effect in order to assess the potential for better and more efficient targeting of specific treatments for individuals with shoulder pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018088298.
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Affiliation(s)
- Danielle A. van der Windt
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Danielle L. Burke
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Opeyemi Babatunde
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Miriam Hattle
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Cliona McRobert
- 0000 0004 1936 8470grid.10025.36School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Chris Littlewood
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Gwenllian Wynne-Jones
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Linda Chesterton
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
| | - Geert J. M. G. van der Heijden
- 0000000084992262grid.7177.6Department of Social Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan C. Winters
- 0000 0000 9558 4598grid.4494.dDepartment of General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daniel I. Rhon
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX USA
| | - Kim Bennell
- 0000 0001 2179 088Xgrid.1008.9Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Edward Roddy
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Staffordshire and Stoke-on-Trent Partnership Trust, Stoke-on-Trent, UK
| | - Carl Heneghan
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Primary Care and Health Science, University of Oxford, Oxford, UK
| | - David Beard
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Jonathan L. Rees
- 0000 0004 1936 8948grid.4991.5Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Richard D. Riley
- 0000 0004 0415 6205grid.9757.cInstitute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Centre for Prognosis Research, Keele University, Keele, UK
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Koorevaar RCT, Kleinlugtenbelt YV, Landman EBM, van 't Riet E, Bulstra SK. Psychological symptoms and the MCID of the DASH score in shoulder surgery. J Orthop Surg Res 2018; 13:246. [PMID: 30286775 PMCID: PMC6172756 DOI: 10.1186/s13018-018-0949-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological symptoms are frequently present in patients scheduled for shoulder surgery. The perception of functional disability, activity level and pain in the shoulder is negatively influenced by psychological symptoms, which leads to higher scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The aim of this study was to determine the influence of psychological symptoms on the minimal clinically important difference (MCID) of the DASH score in patients after shoulder surgery. METHODS In this prospective longitudinal cohort study, 176 patients were included. Group 1 (32 patients) had symptoms of psychological disorders before and after surgery; group 2 had no symptoms of psychological disorders (110 patients). In the remaining patients (34 patients), psychological disorders changed after surgery. Clinical outcome was measured with the change of DASH score and anchor questions for perceived improvement of pain and function after surgery. Symptoms of psychological disorders were identified with the Four-Dimensional Symptom Questionnaire. An anchor-based mean change score technique was used to determine the MCID of the DASH score. RESULTS DASH scores before and 12 months after shoulder surgery were significantly higher in patients with symptoms of psychological disorders; change of DASH score was not different between the two groups. The MCID of the DASH score was 13.0 [SD 20.7] in the group with symptoms of psychological disorders and 12.7 [SD 17.6] in the group with no symptoms of psychological disorders. We observed no difference (p = 0.559) in the MCID between the group with and the group without symptoms of psychological disorders. CONCLUSION Symptoms of psychological disorders had a negative effect on the DASH score but no influence on the MCID of the DASH score. The DASH score could be used in future studies to assess the influence of psychological factors on the clinical outcome of treatment.
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Affiliation(s)
- Rinco C T Koorevaar
- Department of Orthopedics, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands.
| | - Ydo V Kleinlugtenbelt
- Department of Orthopedics, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - Ellie B M Landman
- Department of Orthopedics, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - Esther van 't Riet
- Teaching Hospital/Research Department, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, PO box 30.001, 9700 GB, Groningen, The Netherlands
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Sochacki KR, Brown L, Cenkus K, Di Stasi S, Harris JD, Ellis TJ. Preoperative Depression Is Negatively Associated With Function and Predicts Poorer Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2018; 34:2368-2374. [PMID: 29789247 DOI: 10.1016/j.arthro.2018.03.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/04/2018] [Accepted: 03/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To determine the prevalence of depression in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome and (2) to determine whether depression has a statistically significant and clinically relevant effect on preoperative and postoperative patient-reported outcome scores. METHODS Consecutive subjects undergoing hip arthroscopy for FAI syndrome were retrospectively reviewed. The Beck Depression Inventory-II (BDI-II), Hip Outcome Score (HOS), and 33-item International Hip Outcome Tool (iHOT-33) were administered preoperatively and postoperatively. Clinically relevant differences were defined by the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state. Comparisons between preoperative and postoperative scores were completed. The Spearman correlation coefficient (r) was used to determine the degree of correlation between the BDI-II score, HOS, and iHOT-33 score preoperatively and postoperatively. RESULTS We analyzed 77 patients (72.7% female patients; mean age, 35.2 ± 12.5 years). Depressive symptoms were reported as minimal (75.3%), mild (11.7%), moderate (6.5%), or severe (6.5%). Patients with minimal or mild depression had a superior HOS Activities of Daily Living (Δ17.3 preoperatively [P < .001] and Δ37.8 postoperatively [P < .001]), HOS Sport-Specific Subscore (Δ12.8 preoperatively [P = .002] and Δ52.1 postoperatively [P < .0001]), and iHOT-33 score (Δ15.4 preoperatively [P < .0001] and Δ51.3 postoperatively [P < .0001]) compared with patients with moderate or severe depression. There was a weak to moderate negative correlation between the BDI-II score and iHOT-33 score (r = -0.4614, P < .0001 preoperatively; r = -0.327, P < .0001 at 1 year), HOS Activities of Daily Living (r = -0.531, P < .0001 preoperatively), and HOS Sport-Specific Subscore (r = -0.379, P < .0017 at 1 year). CONCLUSIONS Most patients undergoing hip arthroscopy for FAI have minimal depressive symptoms with the overall prevalence higher than the general population. Patients with minimal or mild depressive symptoms have statistically and clinically better preoperative and postoperative patient-reported outcomes, are more likely to obtain substantial clinical benefit from surgery, and are more likely to reach a patient acceptable symptom state after surgery than patients with moderate to severe depressive symptoms. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Lindsey Brown
- Sports Medicine Research Institute, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Kathleen Cenkus
- Department of Plastic Surgery, The Ohio State University, Columbus, Ohio, U.S.A
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.; School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Sochacki KR, Jack RA, Bekhradi A, Delgado D, McCulloch PC, Harris JD. Are Self-Reported Medication Allergies Associated With Worse Hip Outcome Scores Prior to Hip Arthroscopy? Arthroscopy 2018; 34:1856-1861. [PMID: 29477606 DOI: 10.1016/j.arthro.2018.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if there are significant differences in preoperative patient-reported outcome (PRO) scores in patients with and without self-reported medication allergies undergoing hip arthroscopy. METHODS Consecutive subjects undergoing hip arthroscopy for femoroacetabular impingement (FAI) syndrome by a single surgeon were retrospectively reviewed. PROs were collected within 6 weeks of the date of surgery. PROs included International Hip Outcome Tool (iHOT-12), Hip Outcome Score (HOS), and Short-Form (SF-12) scores. Allergies to medications were self-reported preoperatively within 6 weeks of the date of surgery. Patient demographics were recorded. Bivariate correlations and multivariate regression models were calculated to identify associations with baseline hip outcome scores. RESULTS Two hundred twelve subjects were analyzed (56% female, mean age 35.1 ± 13.2 years). Seventy-two subjects (34%) self-reported allergies (range 1-10; 41 subjects had 1 allergy; 14 subjects had 2; 8 subjects had 3; 2 subjects had 4; 7 subjects had 5 or more). The most commonly reported allergies included penicillin (18), sulfa (13), and codeine (11). Female gender was significantly correlated with number of allergies (Pearson correlation coefficient, 0.188; P < .001). SF-12 Mental Component Score (MCS) was significantly correlated with HOS-ADL (Pearson correlation coefficient, 0.389; P < .001), HOS-SSS (Pearson correlation coefficient, 0.251; P < .001), and iHOT-12 (Pearson correlation coefficient, 0.385; P < .001). There was no significant correlation between number of allergies and all hip PROs. In all multivariate models, the SF-12 MCS had the strongest association with HOS-ADL, HOS-SSS, and iHOT-12 (P < .001 for all). Allergies were not significantly associated with any hip PROs. CONCLUSIONS In patients undergoing hip arthroscopy for FAI syndrome, self-reported medication allergies are not significantly associated with preoperative patient-reported hip outcome scores. LEVEL OF EVIDENCE Level III, retrospective comparative case series.
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Affiliation(s)
- Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Arya Bekhradi
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | - Domenica Delgado
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A
| | | | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, U.S.A..
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Lansdown DA, Ukwuani G, Kuhns B, Harris JD, Nho SJ. Self-reported Mental Disorders Negatively Influence Surgical Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement. Orthop J Sports Med 2018; 6:2325967118773312. [PMID: 29796402 PMCID: PMC5960865 DOI: 10.1177/2325967118773312] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Femoroacetabular impingement (FAI) is responsible for hip pain and dysfunction, and surgical outcomes depend on multiple factors. The presence of mental disorders negatively influences outcomes of multiple orthopaedic conditions, although the impact on FAI surgery is unclear. Hypothesis The authors hypothesized that a preoperative self-reported history of mental disorders would negatively influence patient-reported outcome measures after FAI surgery. Study Design Cohort study; Level of evidence, 3. Methods A matched-cohort study was performed by reviewing a prospectively collected database of cases of arthroscopic management of FAI with a single surgeon over a 2-year period. Demographics and radiographic parameters were recorded for all patients. Patients completed the Hip Outcome Score-Activity of Daily Living Subscale (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS) prior to surgery and 2 years after surgery. Unpaired and paired t tests were used to compare results between and within cohorts at baseline and follow-up. Statistical significance was defined as P < .05. Results The cohort included 301 patients, with 75 and 226 patients reporting and not reporting a history of mental disorders, respectively. Before treatment, all patient-reported outcome measures were significantly lower among patients reporting a history of mental disorders (P < .01 for HOS-ADL, HOS-SSS, and mHHS). Patients in both groups demonstrated significant improvements (P < .0001) in HOS-ADL, HOS-SSS, and mHHS when preoperative outcome measures were compared with follow-up. Patients with reported mental disorders had significantly lower scores after surgery as compared with patients without mental disorders (P < .0001 for HOS-ADL, HOS-SSS, and mHHS). Conclusion The presence of a reported mental disorder is associated with lower patient-reported outcomes before and after surgical management of FAI. Statistically significant and clinically relevant improvements were observed for patients who reported mental disorders. The magnitude of these improvements was not as large as that for an age- and sex-matched control group without a self-reported mental disorder.
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Affiliation(s)
- Drew A Lansdown
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Gift Ukwuani
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center / Midwest Orthopedics, Chicago, Illinois, USA
| | - Benjamin Kuhns
- Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center / Midwest Orthopedics, Chicago, Illinois, USA
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Are Psychosocial Factors Associated With Patient-reported Outcome Measures in Patients With Rotator Cuff Tears? A Systematic Review. Clin Orthop Relat Res 2018; 476:810-829. [PMID: 29481342 PMCID: PMC6260082 DOI: 10.1007/s11999.0000000000000087] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears. However, to our knowledge, a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population. QUESTIONS/PURPOSES (1) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears? (2) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears? METHODS A systematic review of cross-sectional and prospective observational studies was performed in MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science from each database's inception to June 2016. We included studies examining associations between psychosocial factors and patient-reported measures in patients with rotator cuff tears. We excluded studies not reporting on this relationship, involving patients with nonspecific shoulder pain, and written in a language other than English. Two independent reviewers performed the search, extracted information, and assessed methodological quality. Study quality was assessed using the Methodological Items for Non-Randomized Studies (MINORS) criteria. The primary outcomes for the review were associations between each psychosocial factor and patient-reported measures of function or disability, pain, or quality of life. Associations were interpreted based on significance, strength, and direction of the relationship. A total of 10 studies (five cross-sectional and five prospective) in 1410 patients (age range, 46-62 years, 60% [571 of 958] men) were included in the review. Pooling of results for meta-analyses was not possible as a result of study heterogeneity. RESULTS Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies. Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation. Only one psychosocial factor (patient expectation) was weak to moderately associated with patient-reported outcomes after treatment in more than one study. In the two studies that examined expectations, the higher the expectation of benefit, the greater the perceived benefit after surgical intervention. CONCLUSIONS At the initial evaluation of patients with rotator cuff tear, there was an association between self-reported function and pain and emotional or mental health. However, these factors were not associated with patient-reported outcomes after intervention. This finding could be attributed to the lack of large prospective studies in this area or complex phenotypes within this patient population. Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Abstract
To optimize outcomes following elective shoulder surgery, it is important to address not only the injury or pathology itself, but also the cognitive and emotional factors that may influence a patient's recovery. Depression, anxiety, catastrophic thinking, distress, somatization, and decreased self-efficacy are among the most common psychological factors associated with adverse perioperative events and poor postoperative outcomes. Such factors may manifest at any point during recovery. Validated questionnaires can be used to measure psychological factors preoperatively, thereby enabling earlier intervention that may mitigate any potential negative effect of these factors on the patient's overall outcome. Orthopaedic surgeons must be sensitive to the influence of stress, distress, and limited coping strategies on patients and should learn how best to mitigate the detrimental effects of these factors on outcomes after elective shoulder surgery.
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Abstract
Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts.
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Affiliation(s)
- Jason L Codding
- The Rothman Institute at Thomas Jefferson University, Department of Orthopaedic Surgery, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107, USA.
| | - Charles L Getz
- The Rothman Institute at Thomas Jefferson University, Department of Orthopaedic Surgery, 925 Chestnut Street, 5th floor, Philadelphia, PA 19107, USA
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Sharma SP, Moe-Nilssen R, Kvåle A, Bærheim A. Predicting outcome in frozen shoulder (shoulder capsulitis) in presence of comorbidity as measured with subjective health complaints and neuroticism. BMC Musculoskelet Disord 2017; 18:380. [PMID: 28865441 PMCID: PMC5581414 DOI: 10.1186/s12891-017-1740-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/25/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is a substantive lack of knowledge about comorbidity in patients with frozen shoulder. The aim of this study was to investigate whether subjective health complaints and Neuroticism would predict treatment outcome in patients diagnosed with frozen shoulder as measured by the Shoulder Pain and Disability Index (SPADI) and change in SPADI. METHODS A total of 105 patients with frozen shoulder were recruited for a randomised controlled trial, where 69 were in the intervention group and received intraarticular corticosteroid injections and 36 patients served as control group. The SPADI was used as the outcome measure after 8 weeks, and change in SPADI from baseline to 8 weeks as a measure of rate of recovery. To examine comorbidities, all participants completed the Subjective Health Complaints (SHC) questionnaire with its five subscales, and the Neuroticism (N) component of the Eysenck Personality Questionnaire Revised. Multiple regression analysis was performed with the baseline comorbidity variables that correlated significantly with SPADI after 8 weeks, and with change in SPADI from baseline to 8 weeks, controlling for the variables intervention, age, gender and duration of pain. RESULTS In this study, patients with frozen shoulder had little comorbidity as measured with SHC and scored normally with respect to Neuroticism. Only the Pseudoneurology subscale in SHC correlated significantly with SPADI and had significant predictive power (p < 0.001) for the outcome at 8 weeks. The intervention group exhibited significant statistical predictive power (p < 0.001) for the treatment outcome as measured by a change in SPADI from baseline to 8 weeks. Being female also had some predictive significance for change in SPADI (p < 0.005). CONCLUSION Psychometric parameters as measured by the Pseudoneurology subscale in SHC questionnaire did predict the treatment outcome in frozen shoulder as measured by SPADI at 8 weeks, but not by change in SPADI from baseline to 8 weeks. One may conclude that psychometric parameters may affect symptoms, but do not predict the rate of recovery in frozen shoulder. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT01570985 .
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Affiliation(s)
- Satya Pal Sharma
- Research Group, Section for General Practice, Department of Global health and Primary care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Rolf Moe-Nilssen
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Alice Kvåle
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anders Bærheim
- Research Group, Section for General Practice, Department of Global health and Primary care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Andrews P, Steultjens M, Riskowski J. Chronic widespread pain prevalence in the general population: A systematic review. Eur J Pain 2017; 22:5-18. [DOI: 10.1002/ejp.1090] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 01/17/2023]
Affiliation(s)
- P. Andrews
- Institute for Allied Health Research; Glasgow Caledonian University; UK
| | - M. Steultjens
- Institute for Allied Health Research; Glasgow Caledonian University; UK
| | - J. Riskowski
- Institute for Allied Health Research; Glasgow Caledonian University; UK
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Predictors of Postoperative Pain and Narcotic Use After Primary Arthroscopic Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2017. [DOI: 10.1097/bte.0000000000000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tran G, Hensor EMA, Ray A, Kingsbury SR, O'Connor P, Conaghan PG. Ultrasound-detected pathologies cluster into groups with different clinical outcomes: data from 3000 community referrals for shoulder pain. Arthritis Res Ther 2017; 19:30. [PMID: 28183338 PMCID: PMC5304553 DOI: 10.1186/s13075-017-1235-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Ultrasound is increasingly used to evaluate shoulder pain, but the benefits of this are unclear. In this study, we examined whether ultrasound-defined pathologies have implications for clinical outcomes. Methods We extracted reported pathologies from 3000 ultrasound scans of people with shoulder pain referred from primary care. In latent class analysis (LCA), we identified whether individual pathologies clustered in groups. Optimal group number was determined by the minimum Bayesian information criterion. A questionnaire was sent to all patients scanned over a 12-month period (n = 2322). Data collected included demographics, treatments received, current pain and function. The relationship between pathology-defined groups and clinical outcomes was examined. Results LCA revealed four groups: (1) bursitis with limited inflammation elsewhere (n = 1280), (2) bursitis with extensive inflammation (n = 595), (3) rotator cuff tears (n = 558) and (4) limited pathology (n = 567). A total of 777 subjects (33%) completed questionnaires. The median (IQR) duration post-ultrasound scan was 25 (22–29) months. Subsequent injections were most common in groups 1 and 2 (groups 1–4 76%, 67%, 48% and 61%, respectively); surgery was most common in group 3 (groups 1–4 23%, 21%, 28% and 16%, respectively). Shoulder Pain and Disability Index scores were highest in group 3 (median 48 and 30, respectively) and lowest in group 4 (median 32 and 9, respectively). Patients in group 4 who had surgery reported poor outcomes. Conclusions In a community-based population, we identified clusters of pathologies on the basis of ultrasound. Our retrospective data suggest that these groups have different treatment pathways and outcomes. This requires replication in a prospective study to determine the value of a pathology-based classification in people with shoulder pain. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1235-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gui Tran
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Elizabeth M A Hensor
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
| | - Aaron Ray
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Sarah R Kingsbury
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK
| | - Philip O'Connor
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, 2nd Floor, Chapeltown Road, Leeds, LS7 4SA, UK. .,NIHR Leeds Musculoskeletal Biomedical Research Unit, University of Leeds, Leeds, UK. .,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK.
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de Almeida LB, Vieira ER, Zaia JE, de Oliveira Santos BM, Lourenço ARV, Quemelo PRV. Musculoskeletal disorders and stress among footwear industry workers. Work 2017; 56:67-73. [DOI: 10.3233/wor-162463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - José Eduardo Zaia
- Department of Health Promotion, University of Franca, Franca, São Paulo, Brazil
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Bernstein DN, Sood A, Mellema JJ, Li Y, Ring D. Lifetime prevalence of and factors associated with non-traumatic musculoskeletal pains amongst surgeons and patients. INTERNATIONAL ORTHOPAEDICS 2016; 41:31-38. [PMID: 27864586 DOI: 10.1007/s00264-016-3338-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE There is evidence that surgeons make different recommendations for people seeking their care than they make for themselves. There may also be differences in pain episodes and management strategies between surgeons and people seeking care, knowledge of which might improve care. We aimed to assess whether the prevalence of non-traumatic pains, treatments and other factors differed between patients and surgeons. MATERIALS AND METHODS Two-hundred and twenty surgeons, members of the Science of Variation Group (SOVG), and 248 patients seeking care at the Hand Service at a large academic hospital completed a survey regarding the lifetime incidence of non-traumatic pains lasting > one month using short versions of the Pain Catastrophising Scale (PCS-4); Patient Health Questionnaire (PHQ-2); and Short Health Anxiety Inventory (SHAI-5). RESULTS Surgeons had a higher prevalence of at least one non-traumatic pain than patients and were more likely to report pain at more than one anatomical site. Patients were more likely to receive any treatment: surgery; injection; non-opioid medication; opioid medication; physical or occupational therapy. Patients missed work more often than surgeons. Age was the only factor independently associated with patient pain. Practicing in the United States was the only factor independently associated with surgeon pain. CONCLUSIONS Non-traumatic pains are extremely common. Surgeons have particularly effective coping strategies, allowing them to maintain their life roles with limited medical care when in pain. Increasing the appeal and availability of methods for optimising coping strategies might help to narrow the gap between surgeon and patient health.
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Affiliation(s)
- David N Bernstein
- University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 54, Rochester, NY, 14642, USA
| | - Ankit Sood
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jos J Mellema
- Department of Surgery, Rode Kruis Ziekenhuis, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands
| | - Yue Li
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Box CU 420644, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1400 Barbara Jordan Blvd. Suite 2.834; MC: R1800, Austin, TX, 78723, USA.
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Koorevaar RCT, van ‘t Riet E, Gerritsen MJJ, Madden K, Bulstra SK. The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study. PLoS One 2016; 11:e0166555. [PMID: 27846296 PMCID: PMC5112803 DOI: 10.1371/journal.pone.0166555] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/31/2016] [Indexed: 12/02/2022] Open
Abstract
Background Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. Methods and Findings A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function. Conclusions Preoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome.
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Affiliation(s)
| | | | | | - Kim Madden
- Department of Clinical Epidemiology and Biostatistics, Mc Master University, Hamilton, Canada
| | - Sjoerd K. Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Health-related quality of life in patients with chronic rheumatic disease after a multidisciplinary rehabilitation regimen. Qual Life Res 2016; 26:381-391. [PMID: 27600521 DOI: 10.1007/s11136-016-1402-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Multidisciplinary rehabilitation has beneficial effects on health-related quality of life (HRQoL) in patients with chronic rheumatic diseases. However, whether this intervention benefits different age groups in women or men is largely unknown. PURPOSE To investigate HRQoL in patients with chronic rheumatic disease after completion of a 3-week multidisciplinary treatment, with special focus on differences in effect between age and gender groups. METHOD HRQoL was measured with SF-36. Mean scores for all SF-36 domains were compared before and after the 3-week regimen and again at 3-, 6-, and 12-month follow-ups. Multivariable linear regression models using generalized estimating equations to account for repeated measurement were employed. A weighting procedure to account for differential dropouts was applied. RESULTS Three hundred fifty-six women and 74 men with chronic rheumatic disease were included. There were short-term improvements in all SF-36 domains irrespective of age or gender. These effects persisted for up to 1 year in the psychological, social, and energy domains for women under 50. We found no lasting effects for men; however, young men showed similar trends. CONCLUSION Inpatient multidisciplinary rehabilitation improves short-term HRQoL in all patients. Younger women maintain these beneficial effects for up to 1 year. Additional intervention should be considered for elderly women and for men in order to sustain rehabilitation effects.
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Predictors of Early Complications After Rotator Cuff Repair. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Koorevaar RCT, Terluin B, van 't Riet E, Madden K, Bulstra SK. Validation of the four-dimensional symptom questionnaire (4DSQ) and prevalence of psychological symptoms in orthopedic shoulder patients. J Orthop Res 2016; 34:683-91. [PMID: 26379216 DOI: 10.1002/jor.23051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 09/15/2015] [Indexed: 02/04/2023]
Abstract
Psychological problems are common in shoulder patients. A validated psychological questionnaire measuring clinically relevant psychological symptoms (including distress, depression, anxiety, and somatization) in shoulder patients is lacking. The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire to identify distress, depression, anxiety, and somatization which has been validated in primary care populations. The aim of this study was to validate the 4DSQ in orthopedic shoulder patients. We assessed whether the 4DSQ measures these four constructs the same way in an orthopedic population with shoulder problems compared to a general practice population. We also investigated the prevalence of psychological symptoms in shoulder patients. The shoulder group consisted of 200 consecutive patients and the general practice group comprised 368 patients, matched for gender and age. Differential item functioning analysis showed that the 4DSQ measures the different psychological symptoms in orthopedic shoulder patients the same way as in general practice patients. The shoulder patients tended to score higher on the somatization scale, resulting in a new cut-off point for somatization. The prevalence of distress, somatization, anxiety, and depression in the shoulder group was 23%, 14%, 10%, and 8%, respectively. It can be concluded from this study that the 4DSQ in orthopedic shoulder patients measures the same constructs as in general practice patients and can therefore be used in orthopedic practice to measure psychological symptoms in patients with shoulder complaints.
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Affiliation(s)
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther van 't Riet
- Teaching Hospital/Research department, Deventer Hospital, Deventer, The Netherlands
| | - Kim Madden
- Department of Clinical Epidemiology and Biostatistics, Mc Master University, Hamilton, Canada
| | - Sjoerd K Bulstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, The Netherlands
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Wright AR, Shi XA, Busby-Whitehead J, Jordan JM, Nelson AE. The Prevalence of Neck and Shoulder Symptoms and Associations with Comorbidities and Disability: The Johnston County Osteoarthritis Project. ACTA ACUST UNITED AC 2016; 23:34-44. [PMID: 27651037 DOI: 10.3109/10582452.2015.1132026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Neck and shoulder pain are common but underreported by older people, raising important questions of frequency, medical comorbidities, gender and racial disparities and functional impact associated with neck and shoulder symptoms in elders, which we examined in this analysis. METHODS We performed a cross-sectional analysis in the community-based Johnston County Osteoarthritis Project, a cohort that is representative of the U.S. population, utilizing data from 1672 participants with a mean age of 68 years; 69% were white and 68% were women. Trained staff obtained data on participant-reported: symptoms, comorbidities, depression, and functional status; and performance-based functional assessments. Regression models of neck and shoulder symptoms and functional measures were adjusted for age, sex, race, and body mass index, and additionally for other joint symptoms and comorbidities. RESULTS Symptoms of neck (8%), shoulder (13%) or both (13%) were reported by participants. Neck symptoms were most frequently reported by White women; shoulder symptoms were evenly distributed among race and gender subgroups. Neck and shoulder symptoms were associated with cancer, diabetes mellitus, depression, and lung, cardiovascular, and other musculoskeletal problems, as well as pain, aching or stiffness at other sites, and independently with self-reported and performance -based functional measures. CONCLUSIONS These findings suggest that primary health care providers should inquire about neck and shoulder symptoms and address potential underlying causes to improve functional status and decrease disability in older people.
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Affiliation(s)
| | | | - Jan Busby-Whitehead
- University of North Carolina, Department of Medicine, Division of Geriatric Medicine, and Center for Aging and Health, Chapel Hill, NC
| | - Joanne M Jordan
- University of North Carolina Department of Medicine, Division of Rheumatology, Allergy, and Immunology, and Thurston Arthritis Research Center, Chapel Hill, NC; University of North Carolina Department of Orthopaedics, Chapel Hill, NC; University of North Carolina Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
| | - Amanda E Nelson
- University of North Carolina Department of Medicine, Division of Rheumatology, Allergy, and Immunology, and Thurston Arthritis Research Center, Chapel Hill, NC
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The Relationship Between Catastrophic Thinking and Hand Diagram Areas. J Hand Surg Am 2015; 40:2440-6.e5. [PMID: 26409578 DOI: 10.1016/j.jhsa.2015.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/16/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the relationship between the total area marked on pain and numbness diagrams and psychosocial factors (depression, pain catastrophic thinking, and health anxiety). METHODS A total of 155 patients marked painful and numb areas on separate hand diagrams. Patients also completed demographic, condition-related, and psychosocial (Pain Catastrophizing Scale, Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test, and Short Health Anxiety Inventory) questionnaires. Bivariate and multivariable analyses were used to determine factors associated with total area marked on the pain and numbness diagrams. RESULTS The total area marked on the pain diagram correlated with catastrophic thinking, symptoms of depression, and health anxiety. In multivariable analysis, catastrophic thinking was the sole predictor of marked pain area, accounting for 10% of variance in the hand pain diagram. The total area marked on the numbness diagram correlated with the interval between onset and visit, diagnosis, catastrophic thinking, and symptoms of depression. In multivariable analysis, the interval between onset and visit, a diagnosis of carpal tunnel syndrome, and catastrophic thinking were independently associated with total area marked on the hand numbness diagram. CONCLUSIONS Catastrophic thinking was independently associated with larger pain and numbness areas on a hand diagram. This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. Hand diagrams might be used as a basis for discussion of coping strategies and illness behavior in patients with upper extremity conditions. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress. Clin Orthop Relat Res 2015; 473:3501-10. [PMID: 26293222 PMCID: PMC4586226 DOI: 10.1007/s11999-015-4513-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function. In several other areas of orthopaedics, higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery. To our knowledge, the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated. QUESTIONS/PURPOSES (1) Are higher levels of preoperative psychological distress associated with differences in outcome scores (visual analog scale [VAS] for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (2) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores (VAS for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (3) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair? METHODS Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled; 70 patients (82%) were assessed at 1-year followup. During the study period, the three participating surgeons performed 269 rotator cuff repairs; in large part, the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire, and patients completed self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair. Fifty of 85 patients (59%) had normal levels of distress, 26 of 85 (31%) had moderate levels of distress, and nine of 85 (11%) had severe levels of distress. Statistical models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function at 1 year after surgery. RESULTS With the numbers available, distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain (1.9 [95% confidence interval {CI}, 1.0-2.8] versus 1.0 [95% CI, 0.5-1.4], p = 0.10), Simple Shoulder Test (9 [95% CI, 8.1-10.4] versus 11 [95% CI, 10.0-11.0], p = 0.06), or American Shoulder and Elbow Surgeons scores (80 [95% CI, 72-88] versus 88 [95% CI, 84-92], p = 0.08) 1 year after arthroscopic rotator cuff repair. With the numbers available, distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain (3 [95% CI, 2.2-4.1] versus 2 [95% CI, 1.4-2.9], p = 0.10), Simple Shoulder Test (5.2 [95% CI, 3.7-6.6] versus 5.0 [95% CI, 4.2-5.8], p = 0.86), or American Shoulder and Elbow Surgeons scale (38 [95% CI, 29-47] versus 30 [95% CI, 25-36], p = 0.16). The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 (20%) versus 35 of 85 (41%) preoperatively (odds ratio, 0.36; 95% CI, 0.17-0.74; p = 0.005). CONCLUSIONS Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinically important degree in this small series of patients with rotator cuff tears. This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status. LEVEL OF EVIDENCE Level I, prognostic study.
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The effect of feedback regarding coping strategies and illness behavior on hand surgery patient satisfaction and communication: a randomized controlled trial. Hand (N Y) 2015; 10:503-11. [PMID: 26330786 PMCID: PMC4551630 DOI: 10.1007/s11552-015-9742-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients and surgeons can feel uncomfortable discussing coping strategies, psychological distress, and stressful circumstances. It has been suggested that patient-reported outcome measures (PROMs) facilitate the discussion of factors associated with increased symptoms and disability. This study assessed the effect of providing feedback to patients regarding their coping strategy and illness behavior on patient satisfaction and patient-physician communication in orthopedic surgery. METHODS In a prospective study, 136 orthopedic patients were randomly assigned to either receive feedback about the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference computer-adaptive test (CAT) prior to the visit with the hand surgeon or not. The primary outcome was patient satisfaction with the consultation and secondary outcomes involved patient-physician communication. Bivariate and multivariable analyses were performed to determine the influence of the feedback on patient satisfaction and communication. RESULTS There was no significant difference in patient satisfaction between patients who received feedback and patients who did not (P = 0.70). Feedback was associated with more frequent discussion of coping strategies (P = 0.045) in bivariate analysis but was not independently associated: in multivariable analysis, only PROMIS Pain Interference CAT and age were identified as independent predictors (odds ratio (OR) 1.1; 95 % confidence interval (CI) 1.0-1.1, P = 0.013, and OR 0.97, 95 % CI 0.94-0.99, P = 0.032, respectively). No factors were associated with discussion of stressors. Discussion of circumstances was independently associated with increased PROMIS Pain Interference CAT, marital status, and work status. CONCLUSION We found that feedback regarding coping strategies and illness behavior using the PROMIS Pain Interference CAT did not affect patient satisfaction. Although feedback was associated with increased discussion of illness behavior in bivariate analysis, less effective coping strategies and personal factors (age, marital status, and work status) were more important factors.
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A threshold disability score corresponds with an estimated diagnosis of clinical depression in patients with upper extremity disease. Hand (N Y) 2015; 10:168-72. [PMID: 26034425 PMCID: PMC4447652 DOI: 10.1007/s11552-014-9686-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this study was to assess whether there is a threshold Disability of Arm, Shoulder and Hand (DASH) score among patients with common hand diagnoses that corresponds with an estimated diagnosis of clinical depression. METHODS Two hundred sixty-nine patients with one of five common upper extremity disorders completed a measure of upper extremity-specific disability (QuickDASH or DASH) and a questionnaire assessing depressive symptoms (Patient Health Questionnaire (PHQ) or Center for Epidemiologic Studies Depression scale (CES-D). A receiver operating characteristic (ROC) analysis of the discriminatory value of a threshold DASH score for an estimated diagnosis of clinical depression was assessed. The threshold DASH score with the highest positive predictive value for an estimated diagnosis of clinical depression was selected. In bivariate analysis, the association between demographic factors, disease factors, and an estimated diagnosis of clinical depression was examined. RESULTS The area under the ROC curve for a threshold DASH value diagnostic of an estimated diagnosis of clinical depression was 0.75, indicating clinical usefulness for a threshold DASH score as a screening test for depression. The highest positive predictive value of 72 % occurred at a threshold QuickDASH/DASH score of 55. In bivariate analysis, only diagnosis and years of education were significantly different between patients with and without an estimated diagnosis of clinical depression. CONCLUSION A DASH score of 55 or greater in patients with common upper extremity disorders has an acceptable area under the curve and positive predictive value for an estimated diagnosis of clinical depression. LEVEL OF EVIDENCE Level 3, diagnostic study.
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Roiger T, Weidauer L, Kern B. A longitudinal pilot study of depressive symptoms in concussed and injured/nonconcussed National Collegiate Athletic Association Division I student-athletes. J Athl Train 2015; 50:256-61. [PMID: 25562455 PMCID: PMC4477920 DOI: 10.4085/1062-6050-49.3.83] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Depression, which affects millions of Americans each year, among them collegiate student-athletes, can be caused by a wide range of circumstances, including sport-related injuries. OBJECTIVE To longitudinally examine the extent to which National Collegiate Athletic Association Division I student-athletes demonstrated postinjury depressive symptoms. DESIGN Descriptive epidemiologic study. SETTING National Collegiate Athletic Association Division I collegiate athletics. PATIENTS OR OTHER PARTICIPANTS Concussed, injured/nonconcussed, and healthy Division I collegiate student-athletes (aged 18-22 years) competing in men's basketball, football, and wrestling and women's basketball, soccer, and volleyball. MAIN OUTCOME MEASURE(S) Participants completed the Center for Epidemiologic Studies Depression Scale at baseline and at 1 week, 1 month, and 3 months postinjury. We measured differences in depressive scores among concussed, injured/nonconcussed, and healthy participants. Longitudinal changes in postconcussion depressive symptoms were also examined. RESULTS No differences in baseline depressive symptoms among subgroups were noted. After an increase between baseline and 1 week (4.3, 95% confidence interval [CI] = 0.41, 8.16, P = .02), depressive symptoms in the concussion group decreased between 1 week and 1 month (-2.7, 95% CI = -4.96, -0.47, P = .01) and between 1 week and 3 months (-4.0, 95% CI = -6.50, -1.49, P = .004). The injured/nonconcussed group showed differences between baseline and 1 week (4.6, 95% CI = 1.08, 8.17, P = .009) and between baseline and 1 month (3.2, 95% CI = -0.05, 6.30, P = .03). No significant differences were present in depressive symptoms between concussed participants and injured/nonconcussed participants at any of the postinjury time points. CONCLUSIONS Depression may present as a postinjury sequela in Division I collegiate athletes. Athletes who sustain a concussion or other injury resulting in time lost from practice or competition need to be observed carefully for signs and symptoms that may indicate depression. Tools such as the Center for Epidemiologic Studies Depression Scale can be valuable in helping clinicians to recognize and manage depressive symptoms in these individuals.
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Affiliation(s)
| | | | - Bryce Kern
- Sport and Spine Physical Therapy, Wausau, WI
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Potter MQ, Wylie JD, Greis PE, Burks RT, Tashjian RZ. Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears. Clin Orthop Relat Res 2014; 472:3926-32. [PMID: 25080266 PMCID: PMC4397768 DOI: 10.1007/s11999-014-3833-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. QUESTIONS/PURPOSES This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? METHODS Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. RESULTS Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p = 0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p = 0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p < 0.001). Distress remained associated with higher VAS scores (p = 0.001) and lower Simple Shoulder Test (p < 0.001) and American Shoulder and Elbow Surgeons scores (p < 0.001) when age, sex, BMI, American Society of Anesthesiologists classification, smoking status, tear size, and tear retraction were controlled. CONCLUSIONS Higher levels of psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael Q. Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - James D. Wylie
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Patrick E. Greis
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert T. Burks
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert Z. Tashjian
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
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Potter MQ, Wylie JD, Sun GS, Beckmann JT, Aoki SK. Psychologic distress reduces preoperative self-assessment scores in femoroacetabular impingement patients. Clin Orthop Relat Res 2014; 472:1886-92. [PMID: 24574122 PMCID: PMC4016432 DOI: 10.1007/s11999-014-3531-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In several areas of orthopaedics, including spine and upper extremity surgery, patients with greater levels of psychologic distress report worse self-assessments of pain and function than patients who are not distressed. This effect can lead to lower than expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychologic component. QUESTIONS/PURPOSES The purposes of this study were to determine (1) the association of psychologic distress and baseline modified Harris hip scores and Hip Outcome Scores in patients undergoing hip arthroscopy; and (2) whether psychologic distress would remain a significant negative predictor of baseline hip scores when other clinical variables such as age, sex, BMI, smoking status, and American Society of Anesthesiologists (ASA) classification were controlled. METHODS One hundred forty-seven patients at one center were prospectively enrolled when they scheduled hip arthroscopy to treat painful femoroacetabular impingement. Before surgery, psychologic distress was quantified using the Distress Risk Assessment Method questionnaire. Patients also completed baseline self-assessments of hip pain and function including the modified Harris hip score and the Hip Outcome Score. Age, sex, BMI, smoking status, and ASA classification were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychologic distress on patient self-assessment of hip pain and function. RESULTS Patients with distress reported significantly lower baseline modified Harris hip scores (58 versus 67, p = 0.001), Hip Outcome Score-Activities of Daily Living scores (62 versus 72, p = 0.002), and Hip Outcome Score-Sports scores (36 versus 47, p = 0.02). Distress remained significantly associated with lower baseline modified Harris hip (p = 0.006), Hip Outcome Score-Activities of Daily Living (p = 0.005), and Hip Outcome Score-Sports scores (p = 0.017) when age, sex, BMI, smoking status, and ASA classification were controlled for in the multivariate model. CONCLUSIONS Practitioners should recognize that psychologic distress has a negative correlation with baseline patient self-assessment using the modified Harris hip score and the Hip Outcome Scores, scales not previously described to correlate with psychologic distress. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes in patients having hip arthroscopy. LEVEL OF EVIDENCE Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael Q. Potter
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - James D. Wylie
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Grant S. Sun
- />University of Utah School of Medicine, Salt Lake City, UT USA
| | - James T. Beckmann
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Stephen K. Aoki
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
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Abstract
BACKGROUND Previous studies suggest a benefit of mindfulness-based interventions on pain conditions. This study addresses the null hypothesis that mindfulness is not correlated with pain intensity or magnitude of disability in orthopedic upper extremity conditions. METHODS In a prospective cohort, the correlation of the two separate aspects of mindfulness-acceptance and awareness-with disability and pain intensity was tested in patients with nonacute upper extremity conditions. Regression analyses were performed to determine factors associated with arm-specific disability and pain intensity. RESULTS Awareness and acceptance both correlated with arm-specific disability, but only awareness was retained as a predictor in the best multivariable model. Neither awareness nor acceptance correlated with pain intensity. Pain interference and symptoms of depression accounted for more of the variation in disability and pain intensity. CONCLUSION Improved mood and decreased pain interference (a greater sense that one can accomplish one's goals in spite of pain) may be more fruitful than increased mindfulness for patients with nonacute conditions of the upper extremity.
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Affiliation(s)
- Timothy Voskuijl
- />Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- />Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100 55 Fruit Street, Boston, MA 02114 USA , />Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Harvard Medical School, Boston, USA
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Reverse shoulder arthroplasty without subscapularis repair for the treatment of proximal humeral fractures in the elderly. Musculoskelet Surg 2014; 98 Suppl 1:5-13. [PMID: 24659198 DOI: 10.1007/s12306-014-0321-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the short-term results after reverse shoulder arthroplasty (RSA) for proximal humeral fractures in elderly patients. METHODS The same surgical technique was adopted in all patients: the procedure was performed through a deltopectoral approach, the subscapularis was always resected, and a positioning jig was used to implant the cemented humeral component in the desired height and in 20° of retroversion. Nineteen consecutive patients, affected by complex fractures of the proximal humerus, were operated in a 3-year period by the same surgeon at a single institution. All the patients were female, with a mean age of 75 years (range 70-83). RESULTS Fifteen patients were evaluated at an average follow-up of 22 months (range 12-46 months). A postoperative infected hematoma was the only recorded complication. The absolute Constant score averaged 45.7 (range 19-69), while the relative and normalized scores averaged 65.1 (range 33-97) and 58.5 (range 24-91), respectively. The average Shoulder Pain and Disability Index (SPADI) score was 39 (range 6-89). X-rays showed healing of the greater tuberosity to the humeral diaphysis in nine shoulders. CONCLUSIONS RSA is an established treatment option for elderly patients with proximal humeral fractures, particularly when general and local conditions are predictive of failure with hemiarthroplasty. Even though clinical results were quite variable in this series of patients, the adoption of a standardized surgical technique allowed to minimize postoperative complications. Subscapularis repair does not seem a critical factor for preventing implant dislocation, but its influence on functional results needs further investigation.
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Roh YH. Clinical evaluation of upper limb function: Patient's impairment, disability and health-related quality of life. J Exerc Rehabil 2013; 9:400-5. [PMID: 24278892 PMCID: PMC3836539 DOI: 10.12965/jer.130060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 01/22/2023] Open
Abstract
Musculoskeletal disorders substantially impacts physical activity, mental state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome instrument have been introduced to evaluate upper limb function and disability, and these measures can be categorized as patient- or clinician-based, and as condition specific or general health-related QOL evaluations. The upper limb outcome instruments reviewed in this article assess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/interpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condition and health-related QOL in upper limb disorder may help us in decision-making for treatment priority or in interpretation of the treatment outcomes.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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Shan Z, Deng G, Li J, Li Y, Zhang Y, Zhao Q. Correlational analysis of neck/shoulder pain and low back pain with the use of digital products, physical activity and psychological status among adolescents in Shanghai. PLoS One 2013; 8:e78109. [PMID: 24147114 PMCID: PMC3795657 DOI: 10.1371/journal.pone.0078109] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose This study investigates the neck/shoulder pain (NSP) and low back pain (LBP) among current high school students in Shanghai and explores the relationship between these pains and their possible influences, including digital products, physical activity, and psychological status. Methods An anonymous self-assessment was administered to 3,600 students across 30 high schools in Shanghai. This questionnaire examined the prevalence of NSP and LBP and the level of physical activity as well as the use of mobile phones, personal computers (PC) and tablet computers (Tablet). The CES-D (Center for Epidemiological Studies Depression) scale was also included in the survey. The survey data were analyzed using the chi-square test, univariate logistic analyses and a multivariate logistic regression model. Results Three thousand sixteen valid questionnaires were received including 1,460 (48.41%) from male respondents and 1,556 (51.59%) from female respondents. The high school students in this study showed NSP and LBP rates of 40.8% and 33.1%, respectively, and the prevalence of both influenced by the student’s grade, use of digital products, and mental status; these factors affected the rates of NSP and LBP to varying degrees. The multivariate logistic regression analysis revealed that Gender, grade, soreness after exercise, PC using habits, tablet use, sitting time after school and academic stress entered the final model of NSP, while the final model of LBP consisted of gender, grade, soreness after exercise, PC using habits, mobile phone use, sitting time after school, academic stress and CES-D score. Conclusions High school students in Shanghai showed high prevalence of NSP and LBP that were closely related to multiple factors. Appropriate interventions should be implemented to reduce the occurrences of NSP and LBP.
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Affiliation(s)
- Zhi Shan
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
| | - Guoying Deng
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
| | - Jipeng Li
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
| | - Yangyang Li
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
| | - Yongxing Zhang
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
| | - Qinghua Zhao
- Department of Orthopaedic Surgery, Shanghai First People's Hospital, School of Medicine of Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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