Abstract
Objectives:
Mental health is a potential risk factor for worse patient-reported outcomes measures (PROMs) of pain, function, and quality of life across surgical disciplines. With poorer mental health being a risk factor for worse PROMs. In the orthopaedic literature, greater emphasis is being placed on understanding the role mental health has on postoperative outcomes. This has not, however, been extensively explored across all sports medicine arthroscopic surgeries. Furthermore, there is a paucity of data collected from cohorts that control for confounding variables with multivariate analysis. As such, we had the unique opportunity in the orthopaedic Outcome Measurement Evaluation system (OME) cohort to evaluate mental health (mental health composite (MCS) score in VR-12) in arthroscopic procedures of the hip, knee, and shoulder. We hypothesize that worse MCS scores (lower mental health) would be a predictor of worse PROMs in Rotator Cuff Repair, Shoulder Instability, Hip Arthroscopy, Arthroscopic Partial Meniscectomy, and ACLR.
Methods:
We performed an internal review of all prospective studies from the Orthopaedic Outcome Measurement Evaluation system (OME) prospective cohort where multivariate analysis for 1-year patient-reported outcome measures (PROMs) was performed. OME is a cost-effective, scientifically valid, scalable electronic system for collecting PROMs and clinical information surrounding an episode of care. OME leverages the Research Electronic Data Capture (REDCap) database for structured data storage and Health Insurance Portability and Accountability Act (HIPAA) compliance and augments it with additional functionality for multimodal communication with patients and surgeons. Mental health was evaluated with the Veterans RAND 12-Item Health Survey (VR-12), which provides a Mental Component Summary (MCS) score. Selected PROMs (Tables 1 and 2) included those that assess pain and function as well as achievement of a patient-acceptable symptom state (PASS).
Results:
We identified 5 studies that met our inclusion and exclusion criteria (Table 1). Baseline MCS was found to be predictive of statistically significant improvements in 1-year pain and function PROMs for arthroscopic partial meniscectomy, hip arthroscopy, and rotator cuff repair (p<0.05), but not for shoulder instability surgery (Table2). Baseline MCS was not found to be predictive of achievement of a PASS for anterior cruciate ligament reconstruction see (Table 2).
Conclusions:
Our findings demonstrate that MCS is potentially modifiable risk factor for worse PROMs in several of the most common arthroscopic sports medicine procedures being performed. The potentially modifiable risk factor warrants further evaluation to improve outcomes of these common arthroscopic procedures. These could involve randomized control trials that aim to improve preoperative or immediately postoperative MCS in at-risk individuals to determine whether this can lead to a minimal clinically important difference in PROMs.
