The influence of mental health on Patient-Reported Outcomes Measurement Information System (PROMIS) and traditional outcome instruments in patients with symptomatic glenohumeral arthritis

• Published in: Journal of shoulder and elbow surgery 2019-02, Vol.28 (2), p.e40-e48
• Main Authors: Kohan, Eitan M., Hill, J. Ryan, Schwabe, Maria, Aleem, Alexander W., Keener, Jay D., Chamberlain, Aaron M.
• Format: Article
• Language: English
• Subjects: anxiety; depression; function; Glenohumeral arthritis; mental health; outcomes; PROMIS; shoulder
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2018.07.033

The Patient-Reported Outcomes Measurement Information System (PROMIS) assessment includes computerized adaptive tests (CATs) that assess function, pain, depression, and anxiety. The influence of mental health on patients' self-reported pain and function has not been explored using PROMIS in patients with symptomatic glenohumeral osteoarthritis. This cross-sectional study included 284 shoulders in 276 patients presenting with isolated glenohumeral osteoarthritis. All patients completed the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Visual Analog Pain Scale (VAS), and PROMIS CATs at the time of presentation. PROMIS anxiety and depression scores were converted into Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 scores, respectively, using the PROsetta Stone “crosswalk” tool. Mean pain and functional scores were compared between patients with and without PROMIS-converted scores corresponding to a diagnosis of anxiety or depression, as well as between scores corresponding to varying degrees of anxiety or depression. Patients with scores corresponding to a diagnosis of anxiety or depression reported lower functional and higher pain scores compared to those with scores in the normal range (P < .001). Analysis of variance showed progressively lower functional and higher pain scores as anxiety severity increased (P < .001). Similar results were seen with ASES, upper extremity CAT, and pain scores as depression severity increased (P < .001). Functional ASES (P = .004), SST (P < .001), and physical function CAT (P = .002) scores were statistically significantly lower in patients with moderate to severe depression than those without depression or with mild depression. In patients with glenohumeral osteoarthritis, PROMIS-reported anxiety and depression scores, particularly in those with moderate-to-severe scores, correlate with lower functional and higher pain scores. Further investigation is necessary to examine the influence that mental health has on outcomes after operative intervention in this population.