To What Degree do Shoulder Outcome Instruments Reflect Patients’ Psychologic Distress?
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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.
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.
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.
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.
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.
- Alizadehkhaiyat O, Fisher AC, Kemp GJ, Frostick SP. Pain, functional disability, and psychologic status in tennis elbow. Clin J Pain. 2007;23:482–489. CrossRef
- Beaton DE, Richards RR. Measuring function of the shoulder: a cross-sectional comparison of five questionnaires. J Bone Joint Surg Am. 1996;78:882–890.
- Bjelle A. Epidemiology of shoulder problems. Baillieres Clin Rheumatol. 1989;3:437–451. CrossRef
- Boyd JH, Weissman MM, Thompson WD, Myers JK. Screening for depression in a community sample: understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry. 1982;39:1195–1200. CrossRef
- Chard MD, Hazleman R, Hazleman BL, King RH, Reiss BB. Shoulder disorders in the elderly: a community survey. Arthritis Rheum. 1991;34:766–769. CrossRef
- Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.
- Fishbain D. Evidence-based data on pain relief with antidepressants. Ann Med. 2000;32:305–316. CrossRef
- Furner SE, Hootman JM, Helmick CG, Bolen J, Zack MM. Health-related quality of life of US adults with arthritis: analysis of data from the behavioral risk factor surveillance system, 2003, 2005, and 2007. Arthritis Care Res (Hoboken). 2011;63:788–799. CrossRef
- Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007;16:717–721. CrossRef
- Godfrey J, Hamman R, Lowenstein S, 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. CrossRef
- Goldhahn J, Angst F, Simmen BR. What counts: outcome assessment after distal radius fractures in aged patients. J Orthop Trauma. 2008;22(8 suppl):S126–S130. CrossRef
- Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11. CrossRef
- Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand)[corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608. CrossRef
- Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American Academy of Orthopaedic Surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am. 2002;84:208–215.
- Junge A, Frohlich M, Ahrens S, Hasenbring M, Sandler A, Grob D, Dvorak J. Predictors of bad and good outcome of lumbar spine surgery: a prospective clinical study with 2 years’ follow up. Spine (Phila Pa 1976). 1996;21:1056–1064; discussion 1064–1065. CrossRef
- 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. CrossRef
- Kirkley A, Griffin S, Dainty K. Scoring systems for the functional assessment of the shoulder. Arthroscopy. 2003;19:1109–1120. CrossRef
- 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. CrossRef
- Lippitt SB, Harryman DT, Matsen FA. A practical tool for evaluating function: the Simple Shoulder Test. In: Matsen 3rd FA, Fu FH, Hawkins RJ, eds. The Shoulder: A Balance of Mobility and Stability. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1993:501–530
- Macfarlane GJ, Hunt IM, Silman AJ. Predictors of chronic shoulder pain: a population based prospective study. J Rheumatol. 1998;25:1612–1615.
- Masters S, O’Doherty L, Mitchell GK, Yelland M. Acute shoulder pain in primary care: an observational study. Aust Fam Physician. 2007;36:473–476.
- McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain. 1992;50:67–73. CrossRef
- Monnin D, Perneger TV. Scale to measure patient satisfaction with physical therapy. Phys Ther. 2002;82:682–691.
- Oh JH, Jo KH, Kim WS, Gong HS, Han SG, Kim YH. Comparative evaluation of the measurement properties of various shoulder outcome instruments. Am J Sports Med. 2009;37:1161–1168. CrossRef
- Osman A, Barrios FX, Osman JR, Schneekloth R, Troutman JA. The Pain Anxiety Symptoms Scale: psychometric properties in a community sample. J Behav Med. 1994;17:511–522. CrossRef
- Perrot S, Maheu E, Javier RM, Eschalier A, Coutaux A, LeBars M, Bertin P, Bannwarth B, Treves R. Guidelines for the use of antidepressants in painful rheumatic conditions. Eur J Pain. 2006;10:185–192. CrossRef
- Radloff LS. The CES-D Scale: a self teport depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. CrossRef
- 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. CrossRef
- Romeo AA, Bach BR Jr, O’Halloran KL. Scoring systems for shoulder conditions. Am J Sports Med. 1996;24:472–476. CrossRef
- Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14:397–405.
- Ryall C, Coggon D, Peveler R, Poole J, Palmer KT. A prospective cohort study of arm pain in primary care and physiotherapy: prognostic determinants. Rheumatology (Oxford). 2007;46:508–515. CrossRef
- Schiphorst Preuper HR, Reneman MF, Boonstra AM, Dijkstra PU, Versteegen GJ, Geertzen JH, Brouwer S. Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain. Eur Spine J. 2008;17:1448–1456. CrossRef
- Szabo RM. Outcomes assessment in hand surgery: when are they meaningful? J Hand Surg Am. 2001;26:993–1002. CrossRef
- Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients–relapse, noncompliance, and adherence enhancement. Pain. 1991;44:5–28. CrossRef
- van de Ven-Stevens LA, Munneke M, Terwee CB, Spauwen PH, van der Linde H. Clinimetric properties of instruments to assess activities in patients with hand injury: a systematic review of the literature. Arch Phys Med Rehabil. 2009;90:151–169. CrossRef
- van der Windt DA, Kuijpers T, Jellema P, van der Heijden GJ, Bouter LM. Do psychological factors predict outcome in both low-back pain and shoulder pain? Ann Rheum Dis. 2007;66:313–319. CrossRef
- Wolf JM, Green A. Influence of comorbidity on self-assessment instrument scores of patients with idiopathic adhesive capsulitis. J Bone Joint Surg Am. 2002;84:1167–1173. CrossRef
- To What Degree do Shoulder Outcome Instruments Reflect Patients’ Psychologic Distress?
Clinical Orthopaedics and Related Research®
Volume 470, Issue 12 , pp 3470-3477
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- 1. Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
- 2. Department of Orthopaedic Surgery, National Police Hospital, Garakbon-dong, Songpa-gu, Seoul, 138-708, Republic of Korea
- 3. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea