To what degree do shoulder outcome instruments reflect patients' psychologic distress?
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.


OBJECTIVE
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.


METHODS
Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.
Young Hak
YH
Roh
Jung Ho
JH
Noh
Joo Han
JH
Oh
Goo Hyun
GH
Baek
Hyun Sik
HS
Gong
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D059350:Chronic Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D055809:Illness Behavior; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010808:Physical Examination; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012782:Shoulder / Q000503:physiopathology*; D020069:Shoulder Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires