title: Can Preoperative Psychological Assessment Predict Outcomes After Temporomandibular Joint Arthroscopy?
abstract: OBJECTIVE
  Psychological assessment has been used successfully to predict patient outcomes after cardiothoracic and bariatric surgery. The purpose of this study was to determine whether preoperative psychological assessment could be used to predict patient outcomes after temporomandibular joint arthroscopy.
  
  
  METHODS
  Consecutive patients with temporomandibular dysfunction (TMD) who could benefit from arthroscopy were enrolled in a prospective cohort study. All patients completed the Millon Behavior Medicine Diagnostic survey before surgery. The primary predictor variable was the preoperative psychological scores. The primary outcome variable was the difference in pain between the pre- and postoperative periods. The Spearman rank correlation coefficient and the Pearson product-moment correlation were used to determine the association between psychological factors and change in pain. Univariable and multivariable analyses were performed using a mixed-effects linear model and multiple linear regression. A P value of .05 was considered significant.
  
  
  RESULTS
  Eighty-six patients were enrolled in the study. Seventy-five patients completed the study and were included in the final analyses. The mean change in visual analog scale (VAS) pain score 1 month after arthroscopy was -15.4 points (95% confidence interval, -6.0 to -24.7; P < .001). Jaw function also improved after surgery (P < .001). No association between change in VAS pain score and each of the 5 preoperative psychological factors was identified with univariable correlation analyses. Multivariable analyses identified that a greater pain decrease was associated with a longer duration of preoperative symptoms (P = .054) and lower chronic anxiety (P = .064).
  
  
  CONCLUSIONS
  This study has identified a weak association between chronic anxiety and the magnitude of pain decrease after arthroscopy for TMD. Further studies are needed to clarify the role of chronic anxiety in the outcome after surgical procedures for the treatment of TMD.
authors.affiliation: Associate Professor and Residency Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: gfboulo@emory.edu.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Bouloux
authors.affiliation: Former Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Ashley G
authors.initials: AG
authors.lastname: Zerweck
authors.affiliation: Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Celano
authors.affiliation: PhD Student, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Tian
authors.initials: T
authors.lastname: Dai
authors.affiliation: Senior Associate, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: Easley
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D057234:Preoperative Period; D011446:Prospective Studies; D011581:Psychological Tests; D013704:Temporomandibular Joint / Q000601:surgery*; D016896:Treatment Outcome