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Psychologic Distress Reduces Preoperative Self-assessment Scores in Femoroacetabular Impingement Patients

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

Abstract

Background

In several areas of orthopaedics, including spine and upper extremity surgery, patients with greater levels of psychologic distress report worse self-assessments of pain and function than patients who are not distressed. This effect can lead to lower than expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychologic component.

Questions/purposes

The purposes of this study were to determine (1) the association of psychologic distress and baseline modified Harris hip scores and Hip Outcome Scores in patients undergoing hip arthroscopy; and (2) whether psychologic distress would remain a significant negative predictor of baseline hip scores when other clinical variables such as age, sex, BMI, smoking status, and American Society of Anesthesiologists (ASA) classification were controlled.

Methods

One hundred forty-seven patients at one center were prospectively enrolled when they scheduled hip arthroscopy to treat painful femoroacetabular impingement. Before surgery, psychologic distress was quantified using the Distress Risk Assessment Method questionnaire. Patients also completed baseline self-assessments of hip pain and function including the modified Harris hip score and the Hip Outcome Score. Age, sex, BMI, smoking status, and ASA classification were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychologic distress on patient self-assessment of hip pain and function.

Results

Patients with distress reported significantly lower baseline modified Harris hip scores (58 versus 67, p = 0.001), Hip Outcome Score-Activities of Daily Living scores (62 versus 72, p = 0.002), and Hip Outcome Score-Sports scores (36 versus 47, p = 0.02). Distress remained significantly associated with lower baseline modified Harris hip (p = 0.006), Hip Outcome Score-Activities of Daily Living (p = 0.005), and Hip Outcome Score-Sports scores (p = 0.017) when age, sex, BMI, smoking status, and ASA classification were controlled for in the multivariate model.

Conclusions

Practitioners should recognize that psychologic distress has a negative correlation with baseline patient self-assessment using the modified Harris hip score and the Hip Outcome Scores, scales not previously described to correlate with psychologic distress. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes in patients having hip arthroscopy.

Level of Evidence

Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Deveree Partridge MS (Department of Orthopaedics, University of Utah), our study coordinator, 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, James T. Beckmann MD & Stephen K. Aoki MD

  2. University of Utah School of Medicine, Salt Lake City, UT, USA

    Grant S. Sun BS

Authors
  1. Michael Q. Potter MD
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  2. James D. Wylie MD
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  3. Grant S. Sun BS
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  4. James T. Beckmann MD
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  5. Stephen K. Aoki MD
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Corresponding author

Correspondence to Stephen K. Aoki MD.

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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.

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Potter, M.Q., Wylie, J.D., Sun, G.S. et al. Psychologic Distress Reduces Preoperative Self-assessment Scores in Femoroacetabular Impingement Patients. Clin Orthop Relat Res 472, 1886–1892 (2014). https://doi.org/10.1007/s11999-014-3531-z

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  • DOI: https://doi.org/10.1007/s11999-014-3531-z

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