Is Psychological Distress Related to Pat Outcomes in Surgical Repair of Rotator Cuffs

Sanya Kathuria, “Is Psychological Distress Related to Pat Outcomes in Surgical Repair of Rotator Cuffs?”
Mentors: Elizabeth Liedhegner & Bhagwant Sindhu, Biomedical Sciences

Damage to the rotator cuff causes shoulder pain and can lead to surgical repair, a problem that affects approximately 20% of the population with incidence increasing with age. Furthermore, psychological factors have been found to be key determinants of health and can influence patient reported outcomes undergoing a medical treatment. Thus, this study aims to review measures of psychological distress in the context of rotator cuff repair. Factors that cause psychological distress can be hospitalization, surgical outcomes, recovery period, financial burden, social support and absence from work. A variety of self-assessment measures are currently used to measure psychological distress and outcomes of the musculoskeletal surgeries and repair. However, the sensitivity, reliability and validity of these measures are not well defined. The goal of the review is to understand the current measures of psychological distress and evaluate their ability to predict patient outcomes in rotator cuff repair. After a preliminary literature review, patients experiencing greater distress show inferior results on the Visual Analog Scale (VAS) pain scale and low scores on the American Shoulder and Elbow Surgeons Shoulder Score. It was also found that Distress Questionnaire-5 was a better tool to determine psychological distress than Kessler’s Questionnaire-5. No clinically approved definition for psychological distress and biases linked to self-assessed questionnaires are certain limitations to our study. In our future studies, we plan to employ a survey for psychological distress as well as a biomarker for stress, cortisol, to determine if reduction of both perceived stress and the stress hormone, cortisol, can improve patient outcomes for rotator cuff repair surgery. Furthermore, we propose to enroll patients in a mindfulness program to facilitate a reduction of stress and compare these outcomes to patients undergoing standard of care.

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  1. Hi Everyone,
    I am Sanya Kathuria. I am a sophomore studying bio-medical sciences.My mentors are Dr.Elizabeth Liedhegner and Dr.Bhagwant Singh Sindhu. My research topic is,” Is Psychological Distress related to Patient Outcomes in Rotator Cuff Repairs.” We found out that psychological distress was correlated to higher pain scores on the VAS pain scale and higher VAS pain scores were related to poor functional outcomes. Our future goal is to find out how mindful interventions can decrease psychological distress and improve patient outcomes in Rotator Cuff Repairs. Also, assess stress biomarkers like cortisol to determine stress.

  2. Sanya,

    I really enjoyed learning about your research. Nice work on a comprehensive literature review. Your explanation of how you selected the articles, the different psychological tests/assessments, and the summary of the literature was clear and easy to comprehend. Most importantly, you have raised important questions about the relationship between psychological distress and surgical outcomes. I’m sure your competent research methods will serve you well as you explore these questions and relationships in the future here at UWM. I wish you well! Kathryn Amato

  3. Hi Sanya, I really enjoyed reading about your research. Though this is not my area of expertise, your research was easy for me to follow and understand. You defined key terms and kept all information succinct and focused on the main top. It makes sense that distress and lower outcomes are associated.

    I had a little trouble following the results of your findings from your literature review. I was really interested in understanding more about correlation and causation of psychological distress and physical outcomes. I would have liked to have read more about how the studies (if they did) look at psychological distress both before and after treatment. I’m also curious to understand whether the effect size (how much does psychological distress play a role in patient outcomes?) was meaningful or not. I would love to know more about your analysis is regarding the literature you read about. It seems as though there wasn’t enough literature to draw significant conclusions. I’m also curious about whether there were discrepancies among findings in the studies?

    I wish you lots of luck in your future research. I found it very interesting. I hope my questions weren’t too off base as this is new information to me!

    1. Hi Becky,
      To answer some of your questions. Most of the studies involved a questionnaire to measure psychological distress ( either pre or post operative stress). Some of the questionnaires were SF-36, Hospital Anxiety and Depression Scale and Western Ontario Rotator Cuff Index quality of life questionnaire. Patients who were distressed scored low on the mental component on SF-36 and higher on the HADS scale. You correctly mentioned that studies should be done to find correlation between post and pre operative psychological distress. Unfortunately, most of the studies either include only pre or post operative data for psychological distress. But, there have been studies to see how psychological stress is decreased after the surgery and it has been shown that people are at a peace of mind after surgery but unfortunately those studies do not measure their functional outcomes. Also, yes there were some discrepancies, we found studies which showed little or no correlation of psychological distress with post operative functional outcomes. The literature review is meaningful since in the near future we wish to find out how mindful interventions can decrease psychological distress and improve patient outcomes in rotator cuff repairs. Also, we also wish to use a biomarker to have a quantity measure for stress in such patients to increase accuracy. Furthermore, through this literature review we know that psychological distress does affect the surgical outcomes but we are yet to understand what is the best measure to asses the psychological distress. Since, all the studies include patient reported measures it is open to biases and discrepancies. That is another reason why we want to use a biomarker that is cortisol( stress hormone) to measure stress in patients. We wish to measure stress by using a quantitative measure for more accuracy.
      Thanks for your questions and feedback. I hope I answered them all.
      Sanya Kathuria

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