Clinical Orthopaedics and Related Research®

, Volume 472, Issue 6, pp 1886–1892

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

  • Michael Q. Potter
  • James D. Wylie
  • Grant S. Sun
  • James T. Beckmann
  • Stephen K. Aoki
Clinical 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.

References

  1. 1.
    Aprato A, Jayasekera N, Villar RN. Does the modified Harris hip score reflect patient satisfaction after hip arthroscopy? Am J Sports Med. 2012;40:2557–2560.PubMedCrossRefGoogle Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 10-year follow up. Clin Orthop Relat Res. 2010;468:741–746.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper AP, Basheer SZ, Maheshwari R, Regan L, Madan SS. Outcomes of hip arthroscopy: a prospective analysis and comparison between patients under 25 and over 25 years of age. Br J Sports Med. 2013;47:234–238.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Hinman RS, Dobson F, Takla A, O’Donnell J, Bennell KL. What is the most useful patient-reported outcome in femoroacetabular impingement? Test-retest reliability of six questionnaires. Br J Sports Med. 2013 May 18. [Epub ahead of print].Google Scholar
  11. 11.
    Lavernia CJ, Alcerro JC, Brooks LG, Rossi MD. Mental health and outcomes in primary total joint arthroplasty. J Arthroplasty. 2012;27:1276–1282.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    Lodhia P, Slobogean GP, Noonan VK, Gilbart MK. Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology: a systematic review of the clinimetric evidence. Arthroscopy. 2011;27:279–286.PubMedCrossRefGoogle Scholar
  14. 14.
    Main CJ, Wood PL, Hollis S, Spanswick CC, Waddell G. The Distress and 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.CrossRefGoogle Scholar
  15. 15.
    Martin RL, Philippon MJ. Evidence of reliability and responsiveness for the hip outcome score. Arthroscopy. 2008;24:676–682.PubMedCrossRefGoogle Scholar
  16. 16.
    McCarthy JC, Jarrett BT, Ojeifo O, Lee JA, Bragdon CR. What factors influence long-term survivorship after hip arthroscopy? Clin Orthop Relat Res. 2011;469:362–371.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    McCormick F, Nwachukwu BE, Alpaugh K, Martin SD. Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis. Arthroscopy. 2012;28:1359–1364.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    Philippon MJ, Briggs KK, Carlisle JC, Patterson DC. Joint space predicts THA after hip arthroscopy in patients 50 years and older. Clin Orthop Relat Res. 2013;471:2492–2496.PubMedCrossRefGoogle Scholar
  20. 20.
    Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91:16–23.PubMedCrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Saadat E, Martin SD, Thornhill TS, Brownlee SA, Losina E, Katz JN. Factors associated with the failure of surgical treatment for femoroacetabular impingement: review of the literature. Am J Sports Med. 2013 Aug 30. [Epub ahead of print].Google Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    Thorborg K, Roos EM, Bartels EM, Petersen J, Holmich P. Validity, reliability and responsiveness of patient-reported outcome questionnaires when assessing hip and groin disability: a systematic review. Br J Sports Med. 2010;44:1186–1196.PubMedCrossRefGoogle Scholar
  28. 28.
    Trief PM, Grant W, Fredrickson BE. A prospective study of psychological predictors of lumbar surgery outcome. Spine (Phila Pa 1976). 2000;25:2616–2621.Google Scholar
  29. 29.
    Trief PM, Ploutz-Snyder R, Fredrickson B. Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine (Phila Pa 1976). 2006;31:823–830.Google Scholar
  30. 30.
    Vranceanu AM, Barsky A, Ring D. Psychosocial aspects of disabling musculoskeletal pain. J Bone Joint Surg Am. 2009;91:2014–2018.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Michael Q. Potter
    • 1
  • James D. Wylie
    • 1
  • Grant S. Sun
    • 2
  • James T. Beckmann
    • 1
  • Stephen K. Aoki
    • 1
  1. 1.Department of OrthopaedicsUniversity of UtahSalt Lake CityUSA
  2. 2.University of Utah School of MedicineSalt Lake CityUSA

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