Cho Chul-Hyun, Song Kwang-Soon, Hwang Ilseon, Warner Jon J P
Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalsung-ro, Jung-gu, Daegu, 700-712, Korea.
Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Jung-gu, Daegu, Korea.
Clin Orthop Relat Res. 2015 Nov;473(11):3494-500. doi: 10.1007/s11999-015-4258-1.
Recently, psychological status, patient-centered outcomes, and health-related quality of life (HRQoL) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized. The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated.
QUESTIONS/PURPOSES: The primary objective of this study was to investigate changes in psychological status (depression, anxiety, insomnia) and HRQoL after rotator cuff repair. The secondary objective was to assess whether preoperative depression, anxiety, and insomnia predict clinical outcome after rotator cuff repair.
Forty-seven patients who underwent rotator cuff repair prospectively completed the visual analog scale (VAS) pain score, the UCLA Scale, the American Shoulder and Elbow Surgeons' Scale (ASES), the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality-of-life Scale Abbreviated Version (WHOQOL-BREF) before surgery and at 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements. The chi-square test was also used to compare preoperative and postoperative prevalence of depression, anxiety, and insomnia. Finally, multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome.
With surgery, depression, anxiety, and insomnia decreased, whereas quality of life increased. The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3, 4.3 ± 4.3, and 6.6 ± 3.6, respectively, before surgery to 2.1 ± 2.3, 1.4 ± 2.4, and 4.2 ± 3.3, respectively, at 12 months after surgery (HADS-D mean difference 1.6 [95% confidence interval {CI}, 0.6-2.6], p = 0.003; HADS-A mean difference 2.9 [1.5-4.4], p < 0.001; PSQI mean difference 2.4 [1.3-3.4], p < 0.001). The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery (mean difference -7.0 [95% CI, -10.7 to -3.4], p < 0.001). At 12 months after surgery, there were decreases in the prevalence of depression (six of 47 [22.8%] versus three of 47 [6.4%], p = 0.002), anxiety (11 of 47 [23.4%] versus two of 47 [4.3%], p = 0.016), and insomnia (33 of 47 [70.2%] versus 20 of 47 [42.6%], p = 0.022). Preoperative HADS-depression, HADS-anxiety, and PSQI scores did not correlate with the VAS pain score, UCLA, or ASES scores at 12 months after surgery.
Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery. Preoperative depression, anxiety, and insomnia did not predict poor outcome after rotator cuff repair. Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL.
Level II, prospective study.
最近，计划进行或已接受骨科手术患者的心理状态、以患者为中心的结局以及健康相关生活质量（HRQoL）受到了重视。肩袖修复患者术前心理状态与术后临床结局之间的关系尚未得到研究。
问题/目的：本研究的主要目的是调查肩袖修复后心理状态（抑郁、焦虑、失眠）和HRQoL的变化。次要目的是评估术前抑郁、焦虑和失眠是否可预测肩袖修复后的临床结局。
47例接受肩袖修复的患者在术前以及术后3、6和12个月前瞻性地完成了视觉模拟量表（VAS）疼痛评分、加州大学洛杉矶分校（UCLA）评分、美国肩肘外科医师学会（ASES）评分、医院焦虑抑郁量表（HADS）、匹兹堡睡眠质量指数（PSQI）以及世界卫生组织生活质量量表简表（WHOQOL-BREF）。采用重复测量方差分析来评估心理参数和结局指标的系列变化。卡方检验也用于比较术前和术后抑郁、焦虑和失眠的患病率。最后，应用多元回归分析来确定术前心理状态与术后临床结局之间的关系。
随着手术进行，抑郁、焦虑和失眠减轻，而生活质量提高。HADS-D和HADS-A的平均得分以及PSQI的平均得分分别从术前的3.7±3.3、4.3±4.3和6.6±3.6降至术后12个月时的2.1±2.3、1.4±2.4和4.2±3.3（HADS-D平均差异1.6[95%置信区间{CI}，0.6 - 2.6]，p = 0.003；HADS-A平均差异2.9[1.5 - 4.4]，p < 0.001；PSQI平均差异2.4[1.3 - 3.4]，p < 0.001）。WHOQOL-BREF的平均得分从术前的60.4±11.0提高到术后12个月时的67.4±11.8（平均差异 -7.0[95%CI， -10.7至-3.4]，p < 0.001）。术后12个月时，抑郁患病率降低（47例中的6例[22.8%]对47例中的3例[6.4%]，p = 0.002），焦虑患病率降低（47例中的11例[23.4%]对47例中的2例[4.3%]，p = 0.016），失眠患病率降低（47例中的33例[70.2%]对47例中的20例[42.6%]，p = 0.022）。术前HADS-抑郁、HADS-焦虑和PSQI得分与术后12个月时的VAS疼痛评分、UCLA评分或ASES评分均无相关性。
术后3个月起，随着疼痛减轻和功能能力增强，心理状态和HRQoL得到改善。术前抑郁、焦虑和失眠并不能预测肩袖修复术后的不良结局。我们的研究结果表明，成功的肩袖修复可能会改善心理状态和HRQoL。
II级，前瞻性研究。
