Skip to main content

Advertisement

SpringerLink
Log in

Anxiety in the orthopedic patient: using PROMIS to assess mental health

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

This study explored the performance of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety assessment relative to the Depression assessment in orthopedic patients, the relationship between Anxiety with self-reported Physical Function and Pain Interference, and to determine if Anxiety levels varied according to the location of orthopedic conditions.

Methods

This cross-sectional evaluation analyzed 14,962 consecutive adult new-patient visits to a tertiary orthopedic practice between 4/1/2016 and 12/31/2016. All patients completed PROMIS Anxiety, Depression, Physical Function, and Pain Interference computer adaptive tests (CATs) as routine clinical intake. Patients were grouped by the orthopedic service providing care and categorized as either affected with Anxiety if scoring > 62 based on linkage to the Generalized Anxiety Disorder-7 survey. Spearman correlations between the PROMIS scores were calculated. Bivariate statistics assessed differences in Anxiety and Depression scores between patients of different orthopedic services.

Results

20% of patients scored above the threshold to be considered affected by Anxiety. PROMIS Anxiety scores demonstrated a stronger correlation than Depression scores with Physical Function and Pain Interference scores. Patients with spine conditions reported the highest median Anxiety scores and were more likely to exceed the Anxiety threshold than patients presenting to sports or upper extremity surgeons.

Conclusions

One in five new orthopedic patients reports Anxiety levels that may warrant intervention. This rate is heightened in patients needing spine care. Patient-reported Physical Function more strongly correlates with PROMIS Anxiety than Depression suggesting that the Anxiety CAT is a valuable addition to assess mental health among orthopedic patients.

Level of Evidence

Diagnostic level III.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. London, D. A., Stepan, J. G., Boyer, M. I., & Calfee, R. P. (2014). The impact of depression and pain catastrophization on initial presentation and treatment outcomes for atraumatic hand conditions. The Journal of Bone and Joint Surgery. American Volume, 96(10), 806–814.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dekker, A. P., Salar, O., Karuppiah, S. V., Bayley, E., & Kurian, J. (2016). Anxiety and depression predict poor outcomes in arthroscopic subacromial decompression. Journal of Shoulder and Elbow Surgery, 25(6), 873–880.

    Article  PubMed  Google Scholar 

  3. Duivenvoorden, T., Vissers, M. M., Verhaar, J. A., Busschbach, J. J., Gosens, T., Bloem, R. M., et al. (2013). Anxiety and depressive symptoms before and after total hip and knee arthroplasty: A prospective multicentre study. Osteoarthritis and Cartilage, 21(12), 1834–1840.

    Article  PubMed  CAS  Google Scholar 

  4. The American Board of Orthopaedic Surgery Certification Examinations. https://www.abos.org/certification-exams/part-ii/patient-reported-outcomes.aspx. Accessed 12 April 2018.

  5. Driban, J. B., Morgan, N., Price, L. L., Cook, K. F., & Wang, C. (2015). Patient-Reported Outcomes Measurement Information System (PROMIS) instruments among individuals with symptomatic knee osteoarthritis: A cross-sectional study of floor/ceiling effects and construct validity. BMC Musculoskeletal Disorders, 16, 253.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schalet, B. D., Cook, K. F., Choi, S. W., & Cella, D. (2014). Establishing a common metric for self-reported anxiety: Linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. Journal of Anxiety Disorders, 28(1), 88–96.

    Article  PubMed  Google Scholar 

  7. Talaei-Khoei, M., Fischerauer, S. F., Jha, R., Ring, D., Chen, N., & Vranceanu, A. M. (2017). Bidirectional mediation of depression and pain intensity on their associations with upper extremity physical function. Journal of Behavioral Medicine, 41(3), 309–317.

    Article  PubMed  Google Scholar 

  8. Peters, R. M., Menendez, M. E., Mellema, J. J., Ring, D., & Vranceanu, A. M. (2016). Sleep disturbance and upper-extremity disability. Archives of Bone and Joint Surgery, 4(1), 35–40.

    PubMed  PubMed Central  Google Scholar 

  9. Pilkonis, P. A., Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D., et al. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283.

    Article  PubMed  PubMed Central  Google Scholar 

  10. AssessmentCenter. (2015). PROMIS—Anxiety scoring manual https://www.assessmentcenter.net/documents/PROMIS%20Anxiety%20Scoring%20Manual.pdf. Accessed 12 April 2018.

  11. Stone, P. Appendix Table 34: Raw Score to T-Score conversion table for GAD-7 to PROMIS Anxiety. http://www.prosettastone.org/LinkingTables/Documents/PROMIS%20Anxiety%20and%20GAD-7%20Linking%20Table.pdf. Accessed 12 April 2018.

  12. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    Article  PubMed  Google Scholar 

  13. Calkins, K. (2016) Applied statistics-lesson 5: Correlation coefficients. http://www.andrews.edu/~calkins/math/edrm611/edrm05.htm. Accessed 12 April 2018.

  14. Broderick, J. E., Schneider, S., Junghaenel, D. U., Schwartz, J. E., & Stone, A. A. (2013). Validity and reliability of patient-reported outcomes measurement information system instruments in osteoarthritis. Arthritis Care and Research, 65(10), 1625–1633.

    PubMed  Google Scholar 

  15. Yost, K. J., Eton, D. T., Garcia, S. F., & Cella, D. (2011). Minimally important differences were estimated for six Patient-Reported Outcomes Measurement Information System-Cancer scales in advanced-stage cancer patients. Journal of Clinical Epidemiology, 64(5), 507–516.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ho, B., Houck, J. R., Flemister, A. S., Ketz, J., Oh, I., DiGiovanni, B. F., et al. (2016). Preoperative PROMIS scores predict postoperative success in foot and ankle patients. Foot and Ankle International, 37(9), 911–918.

    Article  PubMed  Google Scholar 

  17. Gibbons, C. J., Mills, R. J., Thornton, E. W., Ealing, J., Mitchell, J. D., Shaw, P. J., et al. (2011). Rasch analysis of the hospital anxiety and depression scale (HADS) for use in motor neurone disease. Health and Quality of Life Outcomes, 9, 82.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Amtmann, D., Kim, J., Chung, H., Bamer, A. M., Askew, R. L., Wu, S., et al. (2014). Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis. Rehabilitation Psychology, 59(2), 220–229.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wolfensberger, A., Vuistiner, P., Konzelmann, M., Plomb-Holmes, C., Leger, B., & Luthi, F. (2016). Clinician and patient-reported outcomes are associated with psychological factors in patients with chronic shoulder pain. Clinical Orthopaedics and Related Research, 474(9), 2030–2039.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Skeppholm, M., Fransson, R., Hammar, M., & Olerud, C. (2016). The association between preoperative mental distress and patient reported outcome measures in patients treated surgically for cervical radiculopathy. The Spine Journal, 17, 790–798

    Article  PubMed  Google Scholar 

  21. Koorevaar, R. C., van‘t Riet, E., Gerritsen, M. J., Madden, K., & Bulstra, S. K. (2016). The influence of preoperative and postoperative psychological symptoms on clinical outcome after shoulder surgery: A prospective longitudinal cohort study. PLoS ONE, 11(11), e0166555.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Bagheri, F., Ebrahimzadeh, M. H., Moradi, A., & Bidgoli, H. F. (2016). Factors associated with pain, disability and quality of life in patients suffering from frozen shoulder. Archives of Bone and Joint Surgery, 4(3), 243–247.

    PubMed  PubMed Central  Google Scholar 

  23. Engel-Yeger, B., Keren, A., Berkovich, Y., Sarfaty, E., & Merom, L. (2016). The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disability and Rehabilitation, 1–7.

  24. Tonelli, S. M., Rakel, B. A., Cooper, N. A., Angstom, W. L., & Sluka, K. A. (2011). Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement. Biology of Sex Differences, 2, 12.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Noiseux, N. O., Callaghan, J. J., Clark, C. R., Zimmerman, M. B., Sluka, K. A., & Rakel, B. A. (2014). Preoperative predictors of pain following total knee arthroplasty. The Journal of Arthroplasty, 29(7), 1383–1387.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pinto, P. R., McIntyre, T., Ferrero, R., Almeida, A., & Araujo-Soares, V. (2013). Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. The Journal of Pain, 14(5), 502–515.

    Article  PubMed  Google Scholar 

  27. Ali, A., Lindstrand, A., Sundberg, M., & Flivik, G. (2017). Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: A prospective longitudinal cohort study of 186 patients, with 4-year follow-up. The Journal of Arthroplasty, 32(3), 767–770.

    Article  PubMed  Google Scholar 

  28. Demir, B., Gürsu, S., Yildirim, T., & Er, T. (2012). Evaluation of anxiety levels in patients with chronic orthopedic diseases. Acta Orthopaedica et Traumatologica Turcica, 46(6), 420–424.

    Article  PubMed  Google Scholar 

  29. Attal, N., Masselin-Dubois, A., Martinez, V., Jayr, C., Albi, A., Fermanian, J., et al. (2014). Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort. Brain, 137(Pt 3), 904–917.

    Article  PubMed  Google Scholar 

  30. Talaei-Khoei, M., Riklin, E., Merker, V. L., Sheridan, M. R., Jordan, J. T., Plotkin, S. R., et al. (2016). First use of patient reported outcomes measurement information system (PROMIS) measures in adults with neurofibromatosis. Journal of Neuro-oncology, 131, 413–419.

    Article  PubMed  Google Scholar 

  31. Hermanussen, H. H., Menendez, M. E., Chen, N. C., Ring, D., & Vranceanu, A. M. (2016). Predictors of upper-extremity physical function in older adults. Archives of Bone and Joint Surgery, 4(4), 359–365.

    PubMed  PubMed Central  Google Scholar 

  32. Bot, A. G., Vranceanu, A. M., Herndon, J. H., & Ring, D. C. (2012). Correspondence of patient word choice with psychologic factors in patients with upper extremity illness. Clinical Orthopaedics and Related Research, 470(11), 3180–3186.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Menendez, M. E., Chen, N. C., Mudgal, C. S., Jupiter, J. B., & Ring, D. (2015). Physician empathy as a driver of hand surgery patient satisfaction. Journal of Hand Surgery, 40(9), 1860–1865 e1862.

    Article  PubMed  Google Scholar 

  34. Kawai, K., Kawai, A. T., Wollan, P., & Yawn, B. P. (2017). Adverse impacts of chronic pain on health-related quality of life, work productivity, depression and anxiety in a community-based study. Family Practice, 34(6), 656–661.

    Article  PubMed  Google Scholar 

  35. Coyle, P. C., Velasco, T., Sions, J. M., & Hicks, G. E. (2017). lumbar mobility and performance-based function: An investigation in older adults with and without chronic low back pain. Pain Medicine, 18(1), 161–168.

    Article  PubMed  Google Scholar 

  36. Staner, L. (2003). Sleep and anxiety disorders. Dialogues in Clinical Neuroscience, 5(3), 249–258.

    PubMed  PubMed Central  Google Scholar 

  37. Institute of Medicine (US). Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records. (2014). Capturing social and behavioral domains in electronic health records: Phase 1. Washington, DC: National Academics Press.

    Google Scholar 

  38. Skeppholm, M., Fransson, R., Hammar, M., & Olerud, C. (2017). The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy. The Spine Journal, 17(6), 790–798.

    Article  PubMed  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences Grant UL1TR000448, sub-award TL1TR000449 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842, which supported the maintenance and use of REDCap electronic data capture tools, hosted in the Biostatistics Division of Washington University School of Medicine. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. This funding did not play a direct role in this investigation.

Author information

Authors and Affiliations

  1. Washington University School of Medicine, St. Louis, MO, USA

    Casey M. Beleckas, Heidi Prather, Jason Guattery, Melissa Wright, Michael Kelly & Ryan P. Calfee

Authors
  1. Casey M. Beleckas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidi Prather
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jason Guattery
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Melissa Wright
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryan P. Calfee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan P. Calfee.

Ethics declarations

Conflict of interest

All authors of this manuscript report no conflicts of interest for this research and this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This study was allowed as “exempt” by our Institutional Review Board as no protected health information was accessed and therefore this review of de-identified data did not require written consent from participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beleckas, C.M., Prather, H., Guattery, J. et al. Anxiety in the orthopedic patient: using PROMIS to assess mental health. Qual Life Res 27, 2275–2282 (2018). https://doi.org/10.1007/s11136-018-1867-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-018-1867-7

Keywords

Search

Navigation