One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress

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 One 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 10,000 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 10,000 to USD 100,000 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 100,000 to USD 1,000,000 of research support funding from the Depart...

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

“…Future studies could focus on the prevention of psychological symptoms after shoulder surgery, for example by cognitive treatment, and observe the effect on clinical outcome. Two recent studies, with small study populations, evaluated preoperative psychological distress and functional outcome after rotator cuff surgery [18,19]. Their results are in line with the results found in this study that preoperative symptoms of psychological disorders were not negatively associated with functional outcome after shoulder surgery.…”

“…We observed a disappearance of symptoms of psychological disorders in only 42% of the patients 12 months after surgery, but 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. In the study by Potter et al preoperative psychological distress disappeared in 54% of patients after surgery, 5% of patients with no preoperative psychological distress became distressed after shoulder surgery [18]. Recently, biopsychosocial models have been proposed, suggesting that a complete understanding of pain-related outcomes will require consideration of psychological and social factors, as well as physical and genetic factors [14].…”

“…In orthopaedic literature, preoperative psychological distress such as depression and anxiety has been reported to be associated with worse clinical outcomes after surgery of the hip, knee and lumbar spine [16,17]. In two recent studies, preoperative psychological distress was not associated with clinical outcome after rotator cuff surgery [18,19]. If, however, preoperative psychological status appears to have an impact on the outcome after shoulder surgery, then the identification and treatment of psychological disorders should be an essential part of the preoperative assessment.…”

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

“…Depressive symptoms have been well-described as independent factors related to the DASH, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test [ 3 , 35 ]. In other studies [ 31 , 32 ], distress rather than depression has been investigated using instruments combining depressive and somatic symptoms. Higher level of psychological distress was associated with higher pain and lower function before shoulder arthroscopy.…”

“…For instance, patient-reported outcome measurements (PROMs) generally are improved regardless whether the integrity of the rotator cuff is restored [ 29 ]. There is also no general consensus regarding to what degree psychological distress or social factors may affect medical or surgical treatments [ 21 , 31 , 32 , 44 ]. In 2014, Dunn et al [ 9 ] showed that pain was not related to cuff tear severity, but could be correlated with comorbidities, lower education level, and ethnicity.…”