Abstract
BackgroundPatient-reported outcome measures have become a well-recognised part of outcome assessment in orthopaedic surgery. These questionnaires claim to measure joint-specific dimensions like pain, function in activities of daily living, joint awareness or stiffness. Interference of the patient’s psychological status with these orthopaedic questionnaires however may make accurate interpretation difficult.MethodsWe recruited 356 patients after unilateral, primary THA or TKA and performed a postal survey including the Brief Symptom Inventory (psychological distress measure), the Catastrophising Scale (from the Coping Strategies Questionnaire), the WOMAC score (Western Ontario and McMaster Universities Osteoarthritis Index) and the Forgotten Joint Score – 12 (FJS-12). Associations between the different questionnaires were determined calculating Pearson correlation coefficients. Two multiple linear regression models were used to investigate the impact of socio-demographic variables, clinical variables and of the psychological scales (BSI and Catastrophising Scale) separately for the WOMAC score and the FJS-12.ResultsWOMAC-Total score showed strong correlation to Catastrophising (r = 0.79), BSI-Somatisation (r = 0.63) and BSI-GSI (r = 0.54). The FJS-12 demonstrated modest to strong correlation with Catastrophising (r = −0.60), BSI-Somatisation (r = −0.49) and the BSI-GSI (Global Severity Index) (r = −0.44). BSI-GSI and Catastrophising explained 54.3% of variance in a multivariate regression model for the WOMAC score. The same two scales explained 30.0% of variance for the FJS-12.ConclusionsThere is a strong relationship between psychological status and orthopaedic outcome. The scale names of orthopaedic outcome measures suggest to measure specific dimensions like pain, stiffness, function or joint awareness. In fact they largely include patient’s psychological status indicating poor divergent validity.
Highlights
There is widespread recognition that assessment of patient outcome following total hip and total knee arthroplasty (THA and TKA respectively) should employ patient-reported outcome (PRO) measures
In disease-specific scores that do not have specific mental health components, significant correlation of psychological variables and disease specific variables has been demonstrated [10,11,12]. This interaction is somewhat expected as poor physical outcome and pain after THA/TKA can cause psychological distress and reduce quality of life, or alternatively, poor psychological status can result in worse physical outcome by interfering with the patients’ compliance to treatment [13] and affect pain coping strategies [14]
This study investigated the associations between psychological parameters and physical outcome assessed by two PRO instruments, the WOMAC score and the Forgotten Joint Score – 12 (FJS-12)
Summary
There is widespread recognition that assessment of patient outcome following total hip and total knee arthroplasty (THA and TKA respectively) should employ patient-reported outcome (PRO) measures. PRO assessment instruments have been developed for use with orthopaedic conditions [5,6,7,8] These outcome questionnaires focus mainly on the patients function in typical activities of daily living (ADLs), pain intensity or joint stiffness. In disease-specific scores that do not have specific mental health components, significant correlation of psychological variables and disease specific variables has been demonstrated [10,11,12] This interaction is somewhat expected as poor physical outcome and pain after THA/TKA can cause psychological distress and reduce quality of life, or alternatively, poor psychological status can result in worse physical outcome by interfering with the patients’ compliance to treatment [13] and affect pain coping strategies [14]. Interference of the patient’s psychological status with these orthopaedic questionnaires may make accurate interpretation difficult
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