Clinician and Patient-reported Outcomes Are Associated With Psychological Factors in Patients With Chronic Shoulder Pain

Abstract

BackgroundValidated clinician outcome scores are considered less associated with psychosocial factors than patient-reported outcome measurements (PROMs). This belief may lead to misconceptions if both instruments are related to similar factors.QuestionsWe asked: In patients with chronic shoulder pain, what biopsychosocial factors are associated (1) with PROMs, and (2) with clinician-rated outcome measurements?MethodsAll new patients between the ages of 18 and 65 with chronic shoulder pain from a unilateral shoulder injury admitted to a Swiss rehabilitation teaching hospital between May 2012 and January 2015 were screened for potential contributing biopsychosocial factors. During the study period, 314 patients were screened, and after applying prespecified criteria, 158 patients were evaluated. The median symptom duration was 9 months (interquartile range, 5.5–15 months), and 72% of the patients (114 patients) had rotator cuff tears, most of which were work injuries (59%, 93 patients) and were followed for a mean of 31.6 days (SD, 7.5 days). Exclusion criteria were concomitant injuries in another location, major or minor upper limb neuropathy, and inability to understand the validated available versions of PROMs. The PROMs were the DASH, the Brief Pain Inventory, and the Patient Global Impression of Change, before and after treatment (physiotherapy, cognitive therapy and vocational training). The Constant-Murley score was used as a clinician-rated outcome measurement. Statistical models were used to estimate associations between biopsychosocial factors and outcomes.ResultsGreater disability on the DASH was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.64; 95% CI, 0.25–1.03; p = 0.002) and social factors (language, professional qualification combined coefficient, −6.15; 95% CI, −11.09 to −1.22; p = 0.015). Greater pain on the Brief Pain Inventory was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.076; 95% CI, 0.021–0.13; p = 0.006). Poorer impression of change was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia coefficient, 0.93; 95% CI, 0.87–0.99; p = 0.026) and social factors (education, language, and professional qualification coefficient, 6.67; 95% CI, 2.77–16.10; p < 0.001). Worse clinician-rated outcome was associated only with psychological factors (Hospital Anxiety and Depression Scale (depression only), Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia combined coefficient, −0.35; 95% CI, −0.58 to −0.12; p = 0.003).ConclusionsDepressive symptoms and catastrophizing appear to be key factors influencing PROMs and clinician-rated outcomes. This study suggests revisiting the Constant-Murley score.Level of EvidenceLevel III, prognostic study.

Anxiety in the orthopedic patient: using PROMIS to assess mental health

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“…First, recognizing the relatively high prevalence of anxiety in patients seeing orthopedic surgeons is needed as anxiety is a modifiable disorder that, if treated, can directly impact surgical outcomes in a positive manner. To that end, heightened anxiety is associated with worse patient-reported function, greater pain, and less treatment satisfaction with musculoskeletal conditions [3; 19-27]. Second, although Anxiety and Depression may each be important to understand, if surgeons were only able to collect a single PROMIS assessment of mental health, the reduced floor effect may support the prioritization of PROMIS Anxiety over Depression.…”

Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case‐Control Study

“…Shoulder pain can be negatively affected by psychological factors (ie, anxiety, depression, and catastrophizing symptoms), whereas shoulder disability is influenced by psychological and social factors (ie, language and professional qualification). 32 These factors were not evaluated in the current study and should be considered in future research investigating SAPS.…”

The Effect of Hand Dominance on Functional Outcome Following Single Row Rotator Cuff Repair

“…Patient reported outcome measures are an important research tool for evaluating healthcare outcomes, however they are dependent on numerous factors. Studies evaluating shoulder pain outcome scores in a primarily degenerative rotator cuff tear population found that psychosocial factors such as anxiety, catastophising and depression as well as social factors such as education, language and professional qualification were associated with poorer outcome scores and less perceived improvement in function [ 18 , 19 ]. Various factors have been shown to impact upon the outcome of rotator cuff repair surgery as discussed in the introduction.…”