ASSOCIATION BETWEEN SADNESS AND SYMPTOM SEVERITY IN PEDIATRIC AND ADOLESCENT PATIENTS WITH HIP PAIN

Abstract

Background: Patient-reported outcome measures (PROMs) are used by hip surgeons to assess treatment outcomes. Purpose: The purpose of this study was to evaluate patient-reported sadness and its association with perceived pain, symptoms, and clinical disease severity in patients with hip pain. Methods: A review of prospectively collected PROMs from patients presenting with hip pain was performed. PROMs were completed at baseline, one year, and two years post-treatment. Those who reported feeling ‘downhearted and blue’ sometimes, often, or always on a baseline SF-12 (SAD) were compared to those who did not (NOT SAD). A subset of patients diagnosed with femoroacetabular impingement (FAI) was analyzed to assess radiographic and intraoperative disease severity between the groups. Radiographic measures consisted of baseline alpha angle and lateral center edge angle. Intraoperative disease severity of the femoral head, labrum, acetabulum, and capsule was determined by an orthopaedic surgeon using a standardized 1-3 ranking system. A Mann-Whitney Test was used to compare groups. Results: Of 378 participants, the mean age was 15.3 (range 7-19) and 64.6% were female. Sixty-four participants (16.9%), of which 78.1% were female (p=0.013 compared to male) reported feeling SAD at baseline. SAD participants scored worse on the HOOS at baseline (55.8 vs. 66.1, p<0.001), with significantly lower scores on every subscale (Table 1). Additionally, SAD participants demonstrated worse perceived outcomes one year post-treatment. While not significant, SAD participants also demonstrated a trend towards lower HOOS scores two years post-treatment (Table 1). Of 121 participants diagnosed with FAI (mean age 15.8; 72.7% female), SAD participants reported worse quality of life (29.1 vs. 44.5, p<0.001), pain (52.2 vs. 60.1, p=0.049), physical function (59.7 vs. 68.8, p=0.028), and scored lower overall on the HOOS at baseline (53.8 vs. 62.0, p=0.023). However, SAD participants did not demonstrate worse radiographic or intraoperative disease severity (Table 2). One year post-treatment, SAD participants reported worse pain on the HOOS (68.0 vs. 87.6, p=0.033). There were no significant differences between the SAD and NOT SAD groups at two years post-treatment, but lower scores were noted (Table 1). Conclusion: The question of feeling ‘downhearted or blue,’ perhaps a symptom of underlying depression, may be associated with patient reported symptom severity at baseline and one year post-treatment. However, no differences were found in radiographic or intraoperative disease severity of hip impingement between the SAD and NOT SAD groups, indicating that symptoms of underlying depression may be a risk factor for poor treatment outcomes. [Table: see text][Table: see text]