Skip to main content
SpringerLink
Log in

Psychological Distress Negatively Affects Self-assessment of Shoulder Function in Patients With Rotator Cuff Tears

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J. 2001;1:274–282.

    Article  CAS  PubMed  Google Scholar 

  2. Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J. 2005;5:24–35.

    Article  PubMed  Google Scholar 

  3. Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, McGirt MJ. Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine. 2011;14:261–267.

    Article  PubMed  Google Scholar 

  4. Cho CH, Seo HJ, Bae KC, Lee KJ, Hwang I, Warner JJ. The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elbow Surg. 2013;22:1160–1166.

    Article  PubMed  Google Scholar 

  5. Daubs MD, Hung M, Adams J, Patel AA, Lawrence B, Woodbury A, Brodke DS. Clinical predictors of psychological distress in patients presenting for evaluation of a spinal disorder. Spine J. 2013 Dec 12. pii: S1529-9430(13)01982-7. doi: 10.1016/j.spinee.2013.07.487. [Epub ahead of print]

  6. Daubs MD, Patel AA, Willick SE, Kendall RW, Hansen P, Petron DJ, Brodke DS. Clinical impression versus standardized questionnaire: the spinal surgeon’s ability to assess psychological distress. J Bone Joint Surg Am. 2010;92:2878–2883.

    Article  PubMed  Google Scholar 

  7. Deyo RA, Walsh NE, Schoenfel LS, Ramamurthy S. Studies of the Modified Somatic Perceptions Questionnaire (MSPQ) in patients with back pain: psychometric and predictive properties. Spine (Phila Pa 1976). 1989;14:507–510.

  8. Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine (Phila Pa 1976). 1995;20:2702–2709.

  9. Giesinger JM, Kuster MS, Behrend H, Giesinger K. Association of psychological status and patient-reported physical outcome measures in joint arthroplasty: a lack of divergent validity. Health Qual Life Outcomes. 2013;11:64.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Godfrey J, Hamman R, Lowenstein R, Briggs K, Kocher M. Reliability, validity, and responsiveness of the simple shoulder test: psychometric properties by age and injury type. J Shoulder Elbow Surg. 2007;16:260–267.

    Article  PubMed  Google Scholar 

  11. Kim KW, Han JW, Cho HJ, Chang CB, Park JH, Lee JJ, Lee SB, Seong SC, Kim TK. Association between comorbid depression and osteoarthritis symptom severity in patients with knee osteoarthritis. J Bone Joint Surg Am. 2011;93:556–563.

    Article  PubMed  Google Scholar 

  12. Lavernia CJ, Alcerro JC, Brooks LG, Rossi MD. Mental health and outcomes in primary total joint arthroplasty. J Arthroplasty. 2012;27:1276–1282.

    Article  PubMed  Google Scholar 

  13. Lindenhovius AL, Buijze GA, Kloen P, Ring DC. Correspondence between perceived disability and objective physical impairment after elbow trauma. J Bone Joint Surg Am. 2008;90:2090–2097.

    Article  PubMed  Google Scholar 

  14. Main CJ, Wood PL, Hollis S, Spanswick CC, Waddell G. The Distress Risk Assessment Method: a simple patient classification to identify distress and evaluate the risk of poor outcome. Spine (Phila Pa 1976). 1992;17:42–52.

  15. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11:587–594.

    Article  PubMed  Google Scholar 

  16. Patton CM, Hung M, Lawrence BD, Patel AA, Woodbury AM, Brodke DS, Daubs MD. Psychological distress in a Department of Veterans Affairs spine patient population. Spine J. 2012;12:798–803.

    Article  PubMed  Google Scholar 

  17. Potter MQ, Sun GS, Fraser JA, Beckmann JT, Swenson JD, Maak TG, Aoki SK. Psychological distress in hip arthroscopy patients affects postoperative pain control. Arthroscopy. 2014;30:195–201.

    Article  PubMed  Google Scholar 

  18. Potter MQ, Wylie JD, Sun GS, Beckmann JT, Aoki SK. Psychological distress reduces preoperative self-assessment scores in femoroacetabular impingement patients. Clin Orthop Relat Res. 2014;472:1886–1892.

    Article  PubMed  Google Scholar 

  19. Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am. 2006;88:1983–1988.

    Article  PubMed  Google Scholar 

  20. Ring D, Kadzielski J, Malhotra L, Lee SP, Jupiter JB. Psychological factors associated with idiopathic arm pain. J Bone Joint Surg Am. 2005;87:374–380.

    Article  PubMed  Google Scholar 

  21. Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain. Arch Orthop Trauma Surg. 2012;132:1251–1257.

    Article  PubMed  Google Scholar 

  22. Roh YH, Noh JH, Oh JH, Baek GH, Gong HS. To what degree do shoulder outcome instruments reflect patients’ psychologic distress? Clin Orthop Relat Res. 2012;470:3470–3477.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP. Minimally clinically important differences in ASES and Simple Shoulder Test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am. 2010;92:296–303.

    Article  PubMed  Google Scholar 

  24. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18:927–932.

    Article  PubMed  Google Scholar 

  25. Tashjian RZ, Henn RF, Kang L, Green A. Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am. 2006;88:536–540.

    Article  PubMed  Google Scholar 

  26. Trief PM, Grant W, Fredrickson BE. A prospective study of psychological predictors of lumbar surgery outcome. Spine (Phila Pa 1976). 2000;25:2616–2621.

  27. Trief PM, Ploutz-Snyder R, Fredrickson BE. Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine (Phila Pa 1976). 2006;31:823–830.

  28. Vranceanu AM, Barsky A, Ring D. Psychosocial aspects of disabling musculoskeletal pain. J Bone Joint Surg Am. 2009;91:2014–2018.

    Article  PubMed  Google Scholar 

  29. Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am. 2010;35:956–960.

    Article  PubMed  Google Scholar 

  30. Wylie JD, Bershadsky B, Iannotti JP. The effect of medical comorbidity on self-reported shoulder-specific health related quality of life in patients with shoulder disease. J Shoulder Elbow Surg. 2010;19:823–828.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Erin Granger MPH (Department of Orthopaedics, University of Utah) for her efforts in enrolling patients, documenting informed consent, and administering, scoring, and compiling the questionnaires used in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA

    Michael Q. Potter MD, James D. Wylie MD, Patrick E. Greis MD, Robert T. Burks MD & Robert Z. Tashjian MD

Authors
  1. Michael Q. Potter MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James D. Wylie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick E. Greis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert T. Burks MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Z. Tashjian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Z. Tashjian MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Potter, M.Q., Wylie, J.D., Greis, P.E. et al. Psychological Distress Negatively Affects Self-assessment of Shoulder Function in Patients With Rotator Cuff Tears. Clin Orthop Relat Res 472, 3926–3932 (2014). https://doi.org/10.1007/s11999-014-3833-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3833-1

Keywords

Search

Navigation