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Thorpe A1, O'Sullivan P1, Mitchell T1, Hurworth M2, Spencer J3, Booth G4, Goebel S4, Khoo P5, Tay A3, Smith A1
1Curtin University, School of Physiotherapy and Exercise Science, Perth, Australia, 2Murdoch Orthopaedic Clinic, Perth, Australia, 3Hollywood Orthopaedic Group, Perth, Australia, 4Perth Shoulder Clinic, Perth, Australia, 5Coastal Orthopaedic Group, Perth, Australia
Background: Psychological factors are associated with shoulder pain and disability. Recent research reports mixed findings regarding the association of affective psychological factors with pain and disability outcome after shoulder surgery and the relationship between cognitive psychological factors (thoughts and beliefs) and outcome is unknown.
Purpose: This study aimed to determine (i) if there are identifiable clusters (based on psychological functioning measures) in patients undergoing shoulder surgery, and (ii) if poorer psychological functioning is associated with higher levels of pain and disability after shoulder surgery.
Methods: Four psychological questionnaires (DASS, PSEQ, PCS, TSK) were completed before surgery by 137 patients scheduled for rotator cuff surgery. Pain and disability was measured by the American Shoulder and Elbow Surgeons score (ASES) before, and at 3 and 12 months after surgery. People were statistically grouped according to their pattern of scores on the psychological measures using latent class analysis. The association between psychological subgroups and ASES over time, adjusting for potential confounding variables, was assessed using linear mixed models.
Results: One subgroup with poorer psychological function (40 patients) was associated with worse ASES score at all timepoints when compared to a second subgroup with better psychological function (84 patients) (regression coefficient for ASES: before surgery -9 [95% confidence interval {CI}, -16 to -2], p = 0.011); 3 months after surgery -15 [95% confidence interval {CI}, -23. to -8], p 0.001); and 12 months after surgery -9 [95% confidence interval {CI}, -17 to -1], p = 0.023). This finding was independent of confounding variables. There was no difference in the amount of improvement between the two subgroups across the study period.
Conclusion(s): This study investigated a broad range of psychological factors, encompassing moods, emotions and beliefs, and showed that poorer psychological function before rotator cuff surgery is associated with higher levels of pain and disability before and after surgery.
Implications: Screening of psychological factors before shoulder surgery is recommended to identify patients with poor psychological function. Targeted multidisciplinary interventions directed to psychological factors before or after surgery may improve clinical outcomes, however this is an area that requires further research in the shoulder.
Keywords: shoulder surgery, rotator cuff, psychological
Funding acknowledgements: Australian Postgraduate Award Scholarship, Curtin University Postgraduate Scholarship, Australian Government Research Training Program Scholarship
Purpose: This study aimed to determine (i) if there are identifiable clusters (based on psychological functioning measures) in patients undergoing shoulder surgery, and (ii) if poorer psychological functioning is associated with higher levels of pain and disability after shoulder surgery.
Methods: Four psychological questionnaires (DASS, PSEQ, PCS, TSK) were completed before surgery by 137 patients scheduled for rotator cuff surgery. Pain and disability was measured by the American Shoulder and Elbow Surgeons score (ASES) before, and at 3 and 12 months after surgery. People were statistically grouped according to their pattern of scores on the psychological measures using latent class analysis. The association between psychological subgroups and ASES over time, adjusting for potential confounding variables, was assessed using linear mixed models.
Results: One subgroup with poorer psychological function (40 patients) was associated with worse ASES score at all timepoints when compared to a second subgroup with better psychological function (84 patients) (regression coefficient for ASES: before surgery -9 [95% confidence interval {CI}, -16 to -2], p = 0.011); 3 months after surgery -15 [95% confidence interval {CI}, -23. to -8], p 0.001); and 12 months after surgery -9 [95% confidence interval {CI}, -17 to -1], p = 0.023). This finding was independent of confounding variables. There was no difference in the amount of improvement between the two subgroups across the study period.
Conclusion(s): This study investigated a broad range of psychological factors, encompassing moods, emotions and beliefs, and showed that poorer psychological function before rotator cuff surgery is associated with higher levels of pain and disability before and after surgery.
Implications: Screening of psychological factors before shoulder surgery is recommended to identify patients with poor psychological function. Targeted multidisciplinary interventions directed to psychological factors before or after surgery may improve clinical outcomes, however this is an area that requires further research in the shoulder.
Keywords: shoulder surgery, rotator cuff, psychological
Funding acknowledgements: Australian Postgraduate Award Scholarship, Curtin University Postgraduate Scholarship, Australian Government Research Training Program Scholarship
Topic: Musculoskeletal: upper limb; Orthopaedics; Mental health
Ethics approval required: Yes
Institution: Curtin University and Sir Charles Gairdner Hospital
Ethics committee: Human Research Ethics Committee
Ethics number: HR178/2013 and HREC No:2013-202
All authors, affiliations and abstracts have been published as submitted.
