Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2018 | Research article

Psychological symptoms and the MCID of the DASH score in shoulder surgery

Authors: Rinco C T Koorevaar, Ydo V Kleinlugtenbelt, Ellie B M Landman, Esther van ‘t Riet, Sjoerd K Bulstra

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Abstract

Background

Psychological symptoms are frequently present in patients scheduled for shoulder surgery. The perception of functional disability, activity level and pain in the shoulder is negatively influenced by psychological symptoms, which leads to higher scores of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The aim of this study was to determine the influence of psychological symptoms on the minimal clinically important difference (MCID) of the DASH score in patients after shoulder surgery.

Methods

In this prospective longitudinal cohort study, 176 patients were included. Group 1 (32 patients) had symptoms of psychological disorders before and after surgery; group 2 had no symptoms of psychological disorders (110 patients). In the remaining patients (34 patients), psychological disorders changed after surgery. Clinical outcome was measured with the change of DASH score and anchor questions for perceived improvement of pain and function after surgery. Symptoms of psychological disorders were identified with the Four-Dimensional Symptom Questionnaire. An anchor-based mean change score technique was used to determine the MCID of the DASH score.

Results

DASH scores before and 12 months after shoulder surgery were significantly higher in patients with symptoms of psychological disorders; change of DASH score was not different between the two groups. The MCID of the DASH score was 13.0 [SD 20.7] in the group with symptoms of psychological disorders and 12.7 [SD 17.6] in the group with no symptoms of psychological disorders. We observed no difference (p = 0.559) in the MCID between the group with and the group without symptoms of psychological disorders.

Conclusion

Symptoms of psychological disorders had a negative effect on the DASH score but no influence on the MCID of the DASH score. The DASH score could be used in future studies to assess the influence of psychological factors on the clinical outcome of treatment.

Koorevaar RCT, Terluin B, Van‘t Riet E, Madden K, Bulstra SK. Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) and prevalence of psychological disorders in orthopedic shoulder patients. J Orthop Res. 2016;34:683–91. https://doi.org/10.1002/jor.23051.CrossRefPubMed

Cho CH, Seo HJ, Bae KC, Lee KJ, Hwang I, Warner JJ. The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elb Surg. 2013;22:1160–6. https://doi.org/10.1016/j.jse.2013.02.006.CrossRef

Roh YH, Noh JH, Oh JH, Baek GH, Gong HS. To what degree do shoulder outcome instruments reflect patients’ psychologic distress? Clin Orthop Relat Res. 2012;470:3470–7. https://doi.org/10.1007/s11999-012-2503-4.CrossRefPubMedPubMedCentral

Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain. Arch Orthop Trauma Surg. 2012;132:1251–7. https://doi.org/10.1007/s00402-012-1545-0.CrossRefPubMed

Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB. Self-reported upper extremity health status correlates with depression. J Bone Joint Surg Am. 2006;88:1983–8.PubMed

Koorevaar RC, van 't Riet E, Gerritsen MJ, Madden K, Bulstra SK. The influence of preoperative and postoperative psychological symptoms on clinical outcome after shoulder surgery: a prospective longitudinal cohort study. PLoS One. 2016;11:e0166555. https://doi.org/10.1371/journal.pone.0166555.CrossRefPubMedPubMedCentral

de Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine. New York: Cambridge University Press; 2011.CrossRef

Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10:407–15.CrossRef

Redelmeier DA, Lorig K. Assessing the clinical importance of symptomatic improvements. An illustration in rheumatology. Arch Intern Med. 1993;153:1337–42.CrossRef

10.

van Kampen DA, Willems WJ, van Beers LW, Castelein RM, Scholtes VA, Terwee CB. Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res. 2013;8:40. https://doi.org/10.1186/1749-799X-8-40.CrossRefPubMedPubMedCentral

11.

Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4:11.CrossRef

12.

Beaton DE, van Eerd D, Smith P, van der Velde G, Cullen K, Kennedy CA, Hogg-Johnson S. Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability. J Clin Epidemiol. 2011;64:487–96.CrossRef

13.

Schmitt JS, Di Fabio RP. Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria. J Clin Epidemiol. 2004;57:1008–18.CrossRef

14.

Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014;44:30–9. https://doi.org/10.2519/jospt.2014.4893.CrossRefPubMed

15.

Malay S, SUN Study Group, Chung KC. The minimal clinically important difference after simple decompression for ulnar neuropathy at the elbow. J Hand Surg Am. 2013;38:652–9.CrossRef

16.

Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013;38:641–9. https://doi.org/10.1016/j.jhsa.2012.12.032 Epub 2013 Mar 6.CrossRefPubMedPubMedCentral

17.

Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med. 1996;29:602–8.CrossRef

18.

Desai AS, Dramis A, Hearnden AJ. Critical appraisal of subjective outcome measures used in the assessment of shoulder disability. Ann R Coll Surg Engl. 2010;92:9–13. https://doi.org/10.1308/003588410X12518836440522.CrossRefPubMedPubMedCentral

19.

Veehof MM, Sleegers EJ, van Veldhoven NH, Schuurman AH, van Meeteren NL. Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV). J Hand Ther. 2002;15:347–54.CrossRef

20.

Terluin B, van Marwijk HW, Adèr HJ, et al. The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry. 2006;6:34.CrossRef

21.

Terluin B, Brouwers EP, van Marwijk HW, Verhaak P, van der Horst HE. Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS). BMC Fam Pract. 2009;10:58. https://doi.org/10.1186/1471-2296-10-58.CrossRefPubMedPubMedCentral

22.

Terluin B, Smits N, Miedema B. The English version of the four-dimensional symptom questionnaire (4DSQ) measures the same as the original Dutch questionnaire: a validation study. Eur J Gen Pract. 2014;20:320–6. https://doi.org/10.3109/13814788.2014.905826.CrossRefPubMed

23.

De Vet HCW, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59(10):1033–9. https://doi.org/10.1016/j.jclinepi.2005.10.015.CrossRefPubMed

24.

Terwee CB, Roorda LD, Dekker J, Bierma-Zeinstra SM, Peat G, Jordan KP, Croft P, de Vet HCW: Mind the MIC: large variation among populations and methods. J Clin Epidemiol. 2010;63:524–34.CrossRef

25.

Crosby RD, Kolotkin RL, Williams GR. Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol. 2003;56:395–407.CrossRef

26.

Revicki D, Hays RD, Cella D, et al. Recommended methods for determining responsiveness and minimally important differences for patient-reported outcomes. J Clin Epidemiol. 2008;61:102–9. https://doi.org/10.1016/j.jclinepi.2007.03.012.CrossRefPubMed

27.

Potter MQ, Wylie JD, Granger EK, Greis PE, Burks RT, Tashjian RZ. One-year patient-reported outcomes after arthroscopic rotator cuff repair do not correlate with mild to moderate psychological distress. Clin Orthop Relat Res. 2015;473:3501–10.CrossRef

28.

Cho CH, Song KS, Hwang I, Warner JJ. Does rotator cuff repair improve psychologic status and quality of life in patients with rotator cuff tear? Clin Orthop Relat Res. 2015;473(11):3494–500.CrossRef

29.

King M. A point of minimal important difference (MID): a critique of terminology and methods. Expert Rev Pharmacoecon Outcomes Res. 2011;11:171–84.CrossRef

Title: Psychological symptoms and the MCID of the DASH score in shoulder surgery
Authors: Rinco C T Koorevaar
Ydo V Kleinlugtenbelt
Ellie B M Landman
Esther van ‘t Riet
Sjoerd K Bulstra
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-018-0949-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Psychological symptoms and the MCID of the DASH score in shoulder surgery

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

How do we deliver our findings? Analysis of podium presentations at shoulder meetings

Dynamic hip kinematics during squatting before and after total hip arthroplasty

Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis

The distance of the femoral neurovascular bundle from the hip joint: an intraoperative guide to reduce iatrogenic injury

Effective period of conservative treatment in patients with acute calcific periarthritis of the hand

Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up