Clinician and patient-reported outcomes are associated with psychological factors in chronic shoulder pain patients

Abstract

Multiple factors are affecting outcomes after shoulder injuries and there is no general consensus on which are the most decisive. The research questions were: (1) In patients with chronic shoulder pain, what are the psychosocial and biological factors associated with patient-reported outcome measures? (2) What are the psychosocial and biological factors associated with clinician-rated outcome measures? In this retrospective cohort study, we collected the following biopsychosocial factors: biological (shoulder diagnosis category, Cumulative Illness Rating Scale (CIRS), Abbreviated Injury Scale (AIS) and INTERMED biological subscale), psychological (psychiatric comorbidity, Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and INTERMED psychological subscale) and Social (Native Language, educational level, professional qualification, and INTERMED social subscale). The patient-reported outcomes measures (PROMs) included the DASH, the Brief Pain Inventory (BPI), and Patient Global Impression of Change (PGIC). We used the Constant-Murley score as a clinician-rated outcome instrument. Linear and logistic regression models were used to estimate the association between these variables and outcomes. One hundred and fifty-eight patients (median age 47 years, 18% women) were included, predominantly suffering from rotator cuff tears (72%). Poor patient-reported outcomes are associated with psychological and social factors but not biological factors, where greater disability on the DASH was associated with psychological factors (HAD anxiety, Depression, PCS combined coefficient 0.64 [95% CI: 0.25, 1.03], P = 0.002) and social factors (language, professional qualification combined coefficient −6.15 [−11.09, −1.22], P = 0.015), greater pain on the BPI was associated with psychological factors (HAD anxiety, depression, PCS combined coefficient 0.076 [0.021, 0.13], P = 0.006), and poorer impression of change was associated with psychological factors (HAD anxiety, depression, PCS, TSK coefficient 0.93 [0.87, 0.99], P = 0.026) and social factors (education, language, and professional qualification coefficient 6.67 [2.77, 16.10], P < 0.001). Similarly, worse clinician-rated outcomes were associated with psychological factors (HAD depression, PCS, TSK combined coefficient −0.35 [−0.58, −0.12], P = 0.003). Psychological factors were associated with shoulder patient-reported and clinician-rated outcome instruments. Depressive symptoms, catastrophizing and the patient's social background appear to be key points requiring careful screening. This influence should be taken into account during outcome analysis.