title: Psychologic distress reduces preoperative self-assessment scores in femoroacetabular impingement patients.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
authors.forename: Michael Q
authors.initials: MQ
authors.lastname: Potter
authors.forename: James D
authors.initials: JD
authors.lastname: Wylie
authors.forename: Grant S
authors.initials: GS
authors.lastname: Sun
authors.forename: James T
authors.initials: JT
authors.lastname: Beckmann
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Aoki
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D057925:Femoracetabular Impingement / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D057234:Preoperative Period; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012647:Self-Assessment; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult