Skip to main content

Advertisement

SpringerLink
Log in

Mental health and tobacco use are correlated with PROMIS upper extremity and pain interference scores in patients with shoulder pathology

  • Original Article
  • Published:
MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

To determine whether patient demographics have predictive influence on patient-reported outcomes measurement information system (PROMIS) domains of pain interference (PROMIS-PI), depression (PROMIS-D), and upper extremity (PROMIS-UE) for patients with shoulder pathology treated nonoperatively.

Methods

Patients with partial rotator cuff tears, impingement, scapular dyskinesia, osteoarthritis, muscle strains, biceps tendonitis, instability, and acromioclavicular arthritis were retrospectively identified. Patients who underwent surgery were excluded. Demographic characteristics were documented, and PROMIS scores before and after nonoperative intervention were analyzed for correlations between each domain.

Results

A total of 638 questionnaires (PROMIS-UE, PROMIS-PI, and PROMIS-D) were analyzed. PROMIS-UE had a strong negative correlation with PROMIS-PI (R = − 0.73, P < .001). PROMIS-PI and PROMIS-D demonstrated a positive correlation of moderate strength (R = 0.54, P < .001). Patients who never used tobacco, compared to current or former users, had significantly higher PROMIS-UE scores (34.5 vs. 30.6 and 31.9; P < .001), lower PROMIS-PI (59.7 vs. 63.1 and 60.9; P < .001), and lower PROMIS-D scores (47.3 vs. 52.1 and 49.3; P < .001). Patients with body mass index < 24.8 had significantly higher PROMIS-UE scores than those with > 24.8 (P < .05).

Conclusion

There is an inverse relationship between upper extremity physical function and pain and depression, as measured by PROMIS scores. Smoking and increased BMI are significant contributors to worse outcomes in patients with shoulder pathology, even in nonoperative populations. Counseling patients regarding prognosis and functional outcomes is important in managing their expectations in this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anthony CA, Glass NA, Hancock K, Bollier M, Wolf BR, Hettrich CM (2017) Performance of PROMIS instruments in patients with shoulder instability. Am J Sports Med 45(2):449–453

    Article  Google Scholar 

  2. Ateschrang A, Eggensperger F, Ahrend MD, Schroter S, Stockle U, Kraus TM (2018) Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair. Arch Orthop Trauma Surg 138(6):835–842

    Article  CAS  Google Scholar 

  3. Binshtok AM, Wang H, Zimmermann K et al (2008) Nociceptors are interleukin-1beta sensors. J Neurosci 28(52):14062–14073

    Article  CAS  Google Scholar 

  4. Bishop JY, Santiago-Torres JE, Rimmke N, Flanigan DC (2015) Smoking predisposes to rotator cuff pathology and shoulder dysfunction: a systematic review. Arthroscopy 31(8):1598–1605

    Article  Google Scholar 

  5. Blaine TA, Kim YS, Voloshin I et al (2005) The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elbow Surg 14(1 Suppl S):84–89

    Article  Google Scholar 

  6. Brodke DJ, Saltzman CL, Brodke DS (2016) PROMIS for orthopaedic outcomes measurement. J Am Acad Orthop Surg 24(11):744–749

    Article  Google Scholar 

  7. Carbone S, Gumina S, Arceri V, Campagna V, Fagnani C, Postacchini F (2012) The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. J Shoulder Elbow Surg 21(1):56–60

    Article  Google Scholar 

  8. Cella D, Yount S, Rothrock N et al (2007) The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care 45(5 Suppl 1):S3–S11

    Article  Google Scholar 

  9. Cho CH, Seo HJ, Bae KC, Lee KJ, Hwang I, Warner JJ (2013) The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair. J Shoulder Elbow Surg 22(9):1160–1166

    Article  Google Scholar 

  10. Dowdle SB, Glass N, Anthony CA, Hettrich CM (2017) Use of PROMIS for patients undergoing primary total shoulder arthroplasty. Orthop J Sports Med 5(9):2325967117726044

    PubMed  PubMed Central  Google Scholar 

  11. Fries JF, Witter J, Rose M, Cella D, Khanna D, Morgan-DeWitt E (2014) Item response theory, computerized adaptive testing, and PROMIS: assessment of physical function. J Rheumatol 41(1):153–158

    Article  Google Scholar 

  12. Gotoh M, Hamada K, Yamakawa H et al (2002) Interleukin-1-induced glenohumeral synovitis and shoulder pain in rotator cuff diseases. J Orthop Res 20(6):1365–1371

    Article  CAS  Google Scholar 

  13. Hatta T, Werthel JD, Wagner ER et al (2017) Effect of smoking on complications following primary shoulder arthroplasty. J Shoulder Elbow Surg 26(1):1–6

    Article  Google Scholar 

  14. Ho B, Houck JR, Flemister AS et al (2016) Preoperative PROMIS scores predict postoperative success in foot and ankle patients. Foot Ankle Int 37(9):911–918

    Article  Google Scholar 

  15. Hung M, Baumhauer JF, Latt LD et al (2013) Validation of PROMIS (R) Physical Function computerized adaptive tests for orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 471(11):3466–3474

    Article  Google Scholar 

  16. Kessler KE, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS (2018) Does increased body mass index influence outcomes after rotator cuff repair? Arthroscopy 34(3):754–761

    Article  Google Scholar 

  17. Kukkonen J, Kauko T, Virolainen P, Aarimaa V (2014) Smoking and operative treatment of rotator cuff tear. Scand J Med Sci Sports 24(2):400–403

    Article  CAS  Google Scholar 

  18. Main CJ, Wood PL, Hollis S, Spanswick CC, Waddell G (1992) The distress and risk assessment method. A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine (Phila Pa 1976) 17(1):42–52

    Article  CAS  Google Scholar 

  19. Makhni EC, Meadows M, Hamamoto JT, Higgins JD, Romeo AA, Verma NN (2017) Patient Reported Outcomes Measurement Information System (PROMIS) in the upper extremity: the future of outcomes reporting? J Shoulder Elbow Surg 26(2):352–357

    Article  Google Scholar 

  20. Mukaka MM (2012) Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24(3):69–71

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41(5):582–592

    Google Scholar 

  22. Norman GR, Sloan JA, Wyrwich KW (2004) The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res 4(5):581–585

    Article  Google Scholar 

  23. Potter MQ, Wylie JD, Greis PE, Burks RT, Tashjian RZ (2014) Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears. Clin Orthop Relat Res 472(12):3926–3932

    Article  Google Scholar 

  24. Potter MQ, Wylie JD, Sun GS, Beckmann JT, Aoki SK (2014) Psychologic distress reduces preoperative self-assessment scores in femoroacetabular impingement patients. Clin Orthop Relat Res 472(6):1886–1892

    Article  Google Scholar 

  25. Robins RJ, Anderson MB, Zhang Y, Presson AP, Burks RT, Greis PE (2017) Convergent validity of the Patient-Reported Outcomes Measurement Information System’s Physical Function Computerized Adaptive Test for the knee and shoulder injury sports medicine patient population. Arthroscopy 33(3):608–616

    Article  Google Scholar 

  26. Rothman SM, Huang Z, Lee KE, Weisshaar CL, Winkelstein BA (2009) Cytokine mRNA expression in painful radiculopathy. J Pain 10(1):90–99

    Article  CAS  Google Scholar 

  27. Santiago-Torres J, Flanigan DC, Butler RB, Bishop JY (2015) The effect of smoking on rotator cuff and glenoid labrum surgery: a systematic review. Am J Sports Med 43(3):745–751

    Article  Google Scholar 

  28. Tyser AR, Beckmann J, Franklin JD et al (2014) Evaluation of the PROMIS physical function computer adaptive test in the upper extremity. J Hand Surg Am 39(10):2047–2051.e4

    Article  Google Scholar 

  29. Voloshin I, Gelinas J, Maloney MD, O’Keefe RJ, Bigliani LU, Blaine TA (2005) Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease. Arthroscopy 21(9):1076.e1–1076.e9

    Article  Google Scholar 

  30. Warrender WJ, Brown OL, Abboud JA (2011) Outcomes of arthroscopic rotator cuff repairs in obese patients. J Shoulder Elbow Surg 20(6):961–967

    Article  Google Scholar 

  31. Wylie JD, Suter T, Potter MQ, Granger EK, Tashjian RZ (2016) Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears. J Bone Joint Surg Am 98(4):251–256

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    J. S. Tramer, L. S. Khalil, M. S. Fidai, S. J. Muh, V. Moutzouros & E. C. Makhni

  2. Michigan State University College of Human Medicine, 965 Fee Rd A110, East Lansing, MI, 48824, USA

    J. Meldau

  3. College of Medicine – Central Michigan University, 1280 East Campus Drive, Mount Pleasant, MI, 48859, USA

    G. J. Sheena

Authors
  1. J. S. Tramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. S. Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. S. Fidai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Meldau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. J. Sheena
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. J. Muh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Moutzouros
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. C. Makhni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MF, JT, LK, SM, VM, and EM contributed to the concept and design of the work. JM and GS carried out the chart review and questionnaire documentation. JM and GS created the format of the database, which MF, JT, and LK supervised along with the chart review. SM, VM, and EM reviewed the database for errors. MF, JT, LK, SM, VM, and EM carried out literature review. MF, JT, LK, JM, GS, SM, VM, and EM participated in detailing the statistical analysis request, analyzing the results, and synthesizing tables and figures as well as drafting the manuscript. SM, EM, and VM cross-referenced that statistical results and tables to confirm accuracy. SM, EM, and VM provided feedback and edits to statistical requests, as well as analysis of results. SM, EM, and VM revised drafts of the work. All authors contributed to multiple revisions of the manuscript. SM, VM, and EM are attending physicians who included patients in the study, reviewed the literature cited and statistical analysis requested, revised each draft of the manuscript, and provided mentorship throughout the course of the study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to E. C. Makhni.

Ethics declarations

Conflict of interest

Educational and material support from Stryker, Arthrex, and Pinnacle is disclosed by V.M. Consultation and royalty/material support from Smith & Nephew and Springer are disclosed by E.M. There are no disclosures directly relevant to this work. No other authors report any conflicts of interest.

Ethical approval

This project was reviewed and approved by the Institutional Review Board at Henry Ford Hospital, the main institution of the attending physician conducting the research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tramer, J.S., Khalil, L.S., Fidai, M.S. et al. Mental health and tobacco use are correlated with PROMIS upper extremity and pain interference scores in patients with shoulder pathology. Musculoskelet Surg 106, 69–74 (2022). https://doi.org/10.1007/s12306-020-00674-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12306-020-00674-8

Keywords

Search

Navigation