Authors: Michael Q Potter James D Wylie Erin K Granger Patrick E Greis Robert T Burks Robert Z Tashjian
Publish Date: 2015/08/21
Volume: 473, Issue: 11, Pages: 3501-3510
Abstract
Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative selfassessments 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 investigated1 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 fullthickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repairEightyfive patients with fullthickness rotator cuff tears were prospectively enrolled 70 patients 82 were assessed at 1year 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 selfassessments 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 selfassessment of shoulder pain and function at 1 year after surgeryWith the numbers available distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain 19 95 confidence interval CI 10–28 versus 10 95 CI 05–14 p = 010 Simple Shoulder Test 9 95 CI 81–104 versus 11 95 CI 100–110 p = 006 or American Shoulder and Elbow Surgeons scores 80 95 CI 72–88 versus 88 95 CI 84–92 p = 008 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 1year followup on the VAS for pain 3 95 CI 22–41 versus 2 95 CI 14–29 p = 010 Simple Shoulder Test 52 95 CI 37–66 versus 50 95 CI 42–58 p = 086 or American Shoulder and Elbow Surgeons scale 38 95 CI 29–47 versus 30 95 CI 25–36 p = 016 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 036 95 CI 017–074 p = 0005Mild to moderate levels of distress did not diminish patientreported 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 selflimited 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 statusOne of the authors certifies that he PEG or a member of his immediate family has or may receive payments or benefits during the study period an amount of less than USD 10000 of research support funding from DePuy Mitek Raynham MA USA One of the authors certifies that he RTB or a member of his immediate family has or may receive payments or benefits during the study period an amount of USD 10000 to USD 100000 of research support funding from DePuy Mitek One of the authors certifies that he RZT or a member of his immediate family has or may receive payments or benefits during the study period an amount of USD 100000 to USD 1000000 of research support funding from the Department of Veterans Affairs
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