肩部结局评估工具在多大程度上反映了患者的心理困扰？
To what degree do shoulder outcome instruments reflect patients' psychologic distress?
机构信息
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea.
出版信息
Clin Orthop Relat Res. 2012 Dec;470(12):3470-7. doi: 10.1007/s11999-012-2503-4. Epub 2012 Aug 21.
BACKGROUND
Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores.
QUESTIONS/PURPOSES: We asked (1) to what degree shoulder outcome instruments reflect patients' psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified.
METHODS
We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments.
RESULTS
Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments.
CONCLUSIONS
Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications.
LEVEL OF EVIDENCE
Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
背景
心理困扰会导致多种肌肉骨骼疾病患者的症状加重。虽然有许多肩部评估工具，但目前尚不清楚心理困扰对评分的影响程度以及影响程度如何。
问题/目的：我们提出了以下两个问题：（1）肩部评估工具在多大程度上反映了患者的心理困扰；（2）是否可以识别出那些受心理困扰影响较大的患者。
方法
我们前瞻性评估了 119 例由退行性或炎症性疾病引起的慢性肩部疼痛患者，使用 Constant-Murley 量表、简易肩部测试（SST）和残疾问卷（DASH）进行评估。为了评估心理困扰，我们使用中心流行病学研究抑郁量表（CES-D）评估抑郁，使用疼痛焦虑量表（PASS）评估疼痛焦虑。还测量了人口统计学和临床参数，如疼痛评分、ROM 和外展力量。然后，我们评估了心理困扰和其他临床参数对三种肩部评估工具的定量评分的相对贡献。
结果
肩部评估工具的定量评分与心理困扰的相关性不同。Constant-Murley 评分与心理测量无关，而 SST 评分与 PASS 评分相关（r = 0.32），DASH 评分与 PASS 和 CES-D 评分相关（r = 0.36 和 r = 0.32）。心理困扰会导致 SST 和 DASH 评分恶化，但不会导致 Constant-Murley 评分恶化。与其他两种评估工具相比，DASH 评分受疼痛焦虑和抑郁的影响更大。
结论
肩部评估工具反映了疾病行为的不同心理方面，而心理困扰对不同肩部评估工具的影响程度显然不同。医生在选择和解释肩部评估工具的结果时，应充分考虑其心理影响。
证据等级
2 级，预后研究。欲了解完整的证据等级说明，请参阅作者指南。
Zotero 插件