Effects Of Anxiety And Depression On Self-assessed Pain,Function And Quality Of Sleep In Patients Scheduled For Rotator Cuff Repair

Objective:Rotator cuff disease is the most common cause of shoulder pain and disability.The main clinical manifestations are shoulder pain,muscle weakness and limited functional mobility.In many areas of orthopaedics,patients with greater levels of psychological distress report inferior self assessments of pain and function.This psychosocial factor may influence the patient's preoperative baseline assessment quantification,resulting in a lower than expected baseline score for the average patient.Research has been conducted on the psychological status as an important predictor of the prognosis of treatment of rotator cuff disease and patient satisfaction.Domestic research seldom considers these factors.This paper uses a self-administered questionnaire to investigate the impact of psychological anxiety and depression on preoperative self-rated pain,disability and health-related sleep quality in these patients scheduled for rotator cuff repair.Methods:According to the inclusion criteria,a total of 65 patients who scheduled for rotator cuff repair were selected in Dalian Municipal Central Hospital from January 2016 to December 2017.We used the following self-assessment questionnaire preoperatively: the Hospital Anxiety and Depression Scale(HADS),Visual analog scale pain score,American Shoulder and Elbow Surgeons(ASES)Scale,Simple Shoulder Test(SST)and Pittsburgh Sleep Quality Index(PSQI).Preoperativeevaluation included complete documentation of the following demographic,clinical,and radiologic parameters:age,sex,body mass index(BMI),education level,smoking status,affected side,duration of symptoms,tear size,retraction of the torn tendon,and atrophy and fatty infiltration of the rotator cuff based on Magnetic Resonance Imaging(MRI),and the American Society of Anesthesiologists classification(ASA)is also included in the evaluation.Results: Of the 65 patients studied,15(23.1%)had anxiety,including 10(15.4%)with mild anxiety,4 with moderate anxiety(6.2%)and 1 with severe anxiety(1.5%).Of the 65 patients,17(26.2%)had depression,including 8(12.3%)in mild depression,9(13.9%)in moderate depression and none in severe depression.Patients with higher level of depression had a higher baseline VAS scores(6.0 versus 4.6,p=0.010).HADS anxiety scores was positively correlated with PSQI score(p=0.024)and negatively correlated with ASES,SST scores(p=0.047,p=0.038,respectively);HADS depression scores was positively correlated with VAS pain and PSQI scores(p =0.043,p =0.001,respectively)and negatively correlated with ASES scores and SST scores(p=0.005,p=0.003,respectively).Multivariate analysis using a linear regression model showed that HADS depression scores was an independent predictor of ASES,SST and PSQI scores(p=0.016,p=0.031,p=0.009,respectively);Gender,educational level and tear size were independent predictors of SST scores(p=0.046,p=0.010,p=0.024,respectively).Conclusions: Depression and anxiety had a negative impact on the preoperative self-assessment outcome measurements in patients scheduled for rotator cuff repair.The level of depression was positively correlated with the preoperative pain,sleep quality scores and negatively correlated with shoulder function scores such as ASES and SST scores,which could be used as a predictor of preoperative outcome measurements.The level of anxiety positively correlated with preoperative sleep quality Scores(PSQI)and negatively correlated with the preoperative functional scores,which can be used as a prediction tool for sleep quality and functional scores.Our results suggest that the preoperative psychological status may affect the outcome of rotator cuff repair and should therefore be taken as an important part ofpreoperative assessment,which should draw our clinicians' attention.