Clinical Orthopaedics and Related Research®

, Volume 470, Issue 12, pp 3470–3477 | Cite as

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

  • Young Hak Roh
  • Jung Ho Noh
  • Joo Han Oh
  • Goo Hyun Baek
  • Hyun Sik Gong
Clinical Research

Abstract

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.

Notes

Acknowledgments

We thank P.G. Jung MD and S.Y. Lee MD for their roles in data collection.

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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Young Hak Roh
    • 1
  • Jung Ho Noh
    • 2
  • Joo Han Oh
    • 3
  • Goo Hyun Baek
    • 3
  • Hyun Sik Gong
    • 3
  1. 1.Department of Orthopaedic Surgery, Gil Medical CenterGachon University School of MedicineIncheonKorea
  2. 2.Department of Orthopaedic SurgeryNational Police HospitalSeoulRepublic of Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University College of MedicineSeoulKorea

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