Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
J Shoulder Elbow Surg. 2022 Apr;31(4):681-687. doi: 10.1016/j.jse.2021.09.009. Epub 2021 Oct 14.
Psychological distress is associated with disability and quality of life for patients with shoulder pain. However, uncertainty around heterogeneity of psychological distress has limited the adoption of shoulder care models that address psychological characteristics. In a cohort of patients with shoulder pain, our study sought to (1) describe the prevalence of various subtypes of psychological distress; (2) evaluate associations between psychological distress and self-reported shoulder pain, disability, and function; and (3) determine differences in psychological distress profiles between patients receiving nonoperative vs. operative treatment.
The sample included 277 patients who were evaluated in clinic by a shoulder surgeon and completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Assessment Tool (OSPRO-YF) from 2019 to 2021. This tool categorizes maladaptive and adaptive psychological traits, and the number of yellow flags (YFs) ranges from 0 to 11, with higher YF counts indicating higher pain-related psychological distress. Operative and nonoperative cohorts were compared using χ test and Student t test. Linear regression was used to evaluate the association between pain, disability, and YFs, whereas Poisson regression evaluated the association between operative treatment and psychological distress. K-means cluster analysis was performed to propose potential psychological distress phenotypes.
Two hundred fifty-one patients (91%) had at least 1 YF on the OSPRO-YF tool, with a mean number of 6 ± 3.5 YFs. YFs in unhelpful coping (85%) and helpful coping domains (78%) were most prevalent. The number of YFs was significantly associated with baseline shoulder pain (P < .001), Single Assessment Numeric Evaluation (P < .001), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P < .001) scores. Comparing operative and nonoperative cohorts, the operative cohort had a significantly higher mean number of YFs (6.5 vs. 5.6, P = .035), presence of any YF (94.3% vs. 85.7%, P = .015), and presence of YFs within the unhelpful coping domain (91.8% vs. 75.6%, P < .001). Three phenotypes were described, corresponding to low, moderate, and severe psychological distress (P < .001), with females (P = .037) and smokers (P = .018) associated with higher psychological distress phenotypes.
YFs, particularly within the unhelpful coping and helpful coping domains, were highly prevalent in a cohort of patients presenting to a shoulder surgeon's clinic. Additionally, operative patients were found to have a significantly higher rate of YFs across multiple dimensions of psychological distress. These findings stress the importance of routine attentiveness to multiple dimensions of pain-related psychological distress in shoulder populations, which can provide an opportunity to reinforce healthy interpretation of pain while minimizing distress in appropriately identified patients.
心理困扰与肩痛患者的残疾和生活质量有关。然而，由于对心理困扰的异质性存在不确定性，限制了采用针对心理特征的肩部护理模式。在一组肩痛患者中，我们的研究旨在：(1)描述各种类型心理困扰的患病率；(2)评估心理困扰与自我报告的肩痛、残疾和功能之间的关系；(3)确定接受非手术与手术治疗的患者之间心理困扰特征的差异。
该样本包括 277 名患者，他们在 2019 年至 2021 年期间由肩部外科医生在诊所进行评估，并完成了 Optimal Screening for Prediction of Referral and Outcome Yellow Flag Assessment Tool (OSPRO-YF)。该工具将适应不良和适应良好的心理特征进行分类，黄色标志 (YF) 的数量范围为 0 到 11，YF 计数越高表示与疼痛相关的心理困扰越高。使用卡方检验和学生 t 检验比较手术组和非手术组。线性回归用于评估疼痛、残疾和 YF 之间的关系，而泊松回归用于评估手术治疗与心理困扰之间的关系。K-均值聚类分析用于提出潜在的心理困扰表型。
251 名患者（91%）在 OSPRO-YF 工具上至少有 1 个 YF，平均 YF 数为 6±3.5。无助应对（85%）和有益应对领域（78%）的 YF 最为普遍。YF 数量与基线肩痛（P<.001）、单一评估数字评估（P<.001）和美国肩肘外科医生标准化肩部评估表（P<.001）评分显著相关。比较手术组和非手术组，手术组的 YF 均值明显更高（6.5 比 5.6，P=.035），任何 YF 的存在率（94.3%比 85.7%，P=.015），以及无助应对领域的 YF 存在率（91.8%比 75.6%，P<.001）更高。描述了三种表型，对应于低、中、重度心理困扰（P<.001），女性（P=.037）和吸烟者（P=.018）与较高的心理困扰表型相关。
在向肩部外科医生诊所就诊的患者队列中，YF 尤其是无助应对和有益应对领域的 YF 高度普遍存在。此外，手术患者在多个心理困扰维度上的 YF 发生率明显更高。这些发现强调了在肩部人群中定期关注与疼痛相关的多种心理困扰维度的重要性，这为强化对疼痛的健康解释提供了机会，同时最大限度地减少了在适当确定的患者中减轻痛苦。
