The influence of mental health on Patient-Reported Outcomes Measurement Information System (PROMIS) and traditional outcome instruments in patients with symptomatic glenohumeral arthritis
These authors explored the influence of patients' mental health on their self-reported pain and function using the Patient-Reported Outcomes Measurement Information System (PROMIS) assessment. They performed a cross-sectional study of 284 shoulders in 276 patients presenting with isolated glenohumeral osteoarthritis. All patients completed the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Visual Analog Pain Scale (VAS), and PROMIS CATs at the time of presentation.
These authors explored the influence of patients' mental health on their self-reported pain and function using the Patient-Reported Outcomes Measurement Information System (PROMIS) assessment. They performed a cross-sectional study of 284 shoulders in 276 patients presenting with isolated glenohumeral osteoarthritis. All patients completed the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Visual Analog Pain Scale (VAS), and PROMIS CATs at the time of presentation.
Patients with scores corresponding to a diagnosis of anxiety or depression reported lower functional and higher pain scores compared to those with scores in the normal range (P < .001). The severity of anxiety and depression correlated with a lowering of function and with an increase in pain scores.
The relation of the degree of anxiety and depression to the Simple Shoulder Test score is shown below.
Comment: As the authors point out, this analysis does not determine whether worse mental health is related to more severe glenohumeral arthritis or whether the patients’ anxiety and depressive symptoms create a more intense perception of their limitations. In this regard, it would be of great interest to correlate the radiographic severity of arthritis with the severity of anxiety, the severity of depression and the patient self-assessed comfort and function using a metric such as the Simple Shoulder Test.
We are reminded of an important article from seven years ago, the abstract of which is reproduced below. We have been especially informed by the last part of the last sentence in this abstract.
Background: We sought to investigate the reported association between depression and severity of knee osteoarthritis symptoms stratified by radiographic severity of osteoarthritis and to quantify the contribution made by depression to symptom severity.
Methods: Six hundred and sixty elderly Koreans (sixty-five years or older) were evaluated for radiographic severity of knee osteoarthritis on the basis of the Kellgren-Lawrence grading system and also for symptom severity on the basis of the Western Ontario and McMaster Universities Osteoarthritis Index scales. Patient interviews and a questionnaire that made use of a geriatric depression scale were conducted for the purpose of assessing depressive disorders. Regression analyses were performed to assess the relative contributions by radiographic severity and depression severity to Western Ontario and McMaster Universities Osteoarthritis Index scores and to explore any associations between radiographic severity and the presence of a depressive disorder with regard to the risk of symptomatic knee osteoarthritis. Symptomatic knee osteoarthritis was defined as a Western Ontario and McMaster Universities Osteoarthritis Index score of ≥39.
Results: The presence of a depressive disorder was found to be associated with an increased risk of symptomatic knee osteoarthritis (odds ratio = 5.87 [95% confidence interval, 3.01 to 11.44]). However, the influence of the presence of a depressive disorder was limited to subjects with a radiographic severity of minimal to moderate (Kellgren-Lawrence grade 0 to 3). The presence of a depressive disorder was not associated with the risk of symptomatic knee osteoarthritis in subjects with severe osteoarthritis (Kellgren-Lawrence grade 4).
Conclusions: This study indicates that the assessment and management of coexisting depression should be integrated with the assessment and management of knee osteoarthritis, particularly when radiographic changes of osteoarthritis in the knee joint are not severe.
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