To What Degree do Shoulder Outcome Instruments Reflect Patients' Psychologic Distress?

Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 08/2012; 470(12). DOI: 10.1007/s11999-012-2503-4
Source: PubMed


BACKGROUND: Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores. QUESTIONS/PURPOSES: We asked (1) to what degree shoulder outcome instruments reflect patients' psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified. METHODS: We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments. RESULTS: Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments. CONCLUSIONS: Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications. LEVEL OF EVIDENCE: Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

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    • "Psychologic distress, such as pain-induced anxiety or depression, is increasingly recognized as contributing to pain and disability perception in several musculoskeletal disorders (Kim et al., 2011; Roh et al., 2012d). Depression has been reported to be highly prevalent in the elderly and consistently contributes to symptom severity in some musculoskeletal disorders (Roh et al., 2012b; Rosemann et al., 2007; Salaffi et al., 1991) Furthermore, subjective factors, such as pain and depression, have been reported to have greater influences when disability is measured with respect to functions related to the entire upper extremity, i.e. "
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