Broekman Melle, Brinkman Niels, Thomas Jacob E, Doornberg Job, Spekenbrink-Spooren Anneke, Gosens Taco, Ring David, van den Bekerom Michel
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA; Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands.
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA.
J Shoulder Elbow Surg. 2025 Apr;34(4):979-986. doi: 10.1016/j.jse.2024.07.034. Epub 2024 Sep 11.
Mounting evidence suggests that mental health accounts for greater variation in levels of comfort and capability than pathophysiology severity across a range of musculoskeletal conditions. Using nationwide Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Interventies) data, we tested the null hypothesis that none of the available mental, social, and pathophysiological factors are associated with variation in levels of comfort and capability among people with shoulder osteoarthritis (OA) prior to arthroplasty.
We included all adult patients who underwent primary total shoulder arthroplasty for OA in the period 2014-2021 with complete measures of shoulder specific capability (Oxford Shoulder Score), pain intensity (10-point Numeric Rating Scale), general wellbeing (the EQ-5D 3-L), the grade of pathophysiology (Walch classification) and categorized social health based on a social deprivation index. In total, 1342 patients with shoulder OA preparing for shoulder arthroplasty were included in a regression analysis to seek factors associated with variation in levels of pain intensity and capability.
Greater pain intensity at rest was associated with greater symptoms of anxiety and depression (regression coefficient [RC] = -0.41; 95% confidence interval [CI] = 0.17-0.64; P < .01) and women (RC = 0.38; 95% CI = 0.11-0.66; P < .01). Greater incapability was associated with greater symptoms of anxiety and depression (RC = -3.2; 95% CI = -4.0 to -2.4; P < .01), an American Society of Anesthesiologists score of III and IV (RC = -3.1; 95% CI = -4.8 to -1.4; P < .01), older age (RC = -0.098; 95% CI = -0.15 to -0.047; P <. 01), and women (RC = -3.9; 95% CI = -4.9 to -3.0; P < .01). Neither comfort nor capability were associated with Walch classification or social deprivation index.
The confirmation that variation in levels of comfort and capability among people preparing for shoulder arthroplasty are associated with mindset rather than a measure of glenoid pathophysiology points to the potential benefits of addressing mental health in musculoskeletal health strategies.
越来越多的证据表明，在一系列肌肉骨骼疾病中，心理健康比病理生理严重程度在舒适度和能力水平上的差异更大。我们利用荷兰全国关节成形术登记处（Landelijke Registratie Orthopedische Interventies）的数据，检验了以下零假设：在肩关节骨关节炎（OA）患者进行关节成形术之前，现有的心理、社会和病理生理因素均与舒适度和能力水平的差异无关。
我们纳入了2014年至2021年期间因OA接受初次全肩关节置换术的所有成年患者，这些患者对肩部特定能力（牛津肩部评分）、疼痛强度（10分数字评分量表）、总体健康状况（EQ-5D 3-L）、病理生理分级（Walch分类）进行了完整测量，并根据社会剥夺指数对社会健康状况进行了分类。共有1342例准备进行肩关节置换术的肩部OA患者纳入回归分析，以寻找与疼痛强度和能力水平差异相关的因素。
静息时疼痛强度越大，焦虑和抑郁症状越严重（回归系数[RC]=-0.41；95%置信区间[CI]=0.17-0.64；P<.01），女性也是如此（RC=0.38；95%CI=0.11-0.66；P<.01）。能力越低，焦虑和抑郁症状越严重（RC=-3.2；95%CI=-4.0至-2.4；P<.01），美国麻醉医师协会评分为III级和IV级（RC=-3.1；95%CI=-4.8至-1.4；P<.01），年龄越大（RC=-0.098；95%CI=-0.15至-0.047；P<.01），女性也是如此（RC=-3.9；95%CI=-4.9至-3.0；P<.01）。舒适度和能力均与Walch分类或社会剥夺指数无关。
准备进行肩关节置换术的患者舒适度和能力水平的差异与心理状态而非关节盂病理生理指标相关，这一结果表明在肌肉骨骼健康策略中关注心理健康可能带来潜在益处。
