Aims Psychological factors play a critical role in patient presentation, satisfaction, and outcomes. Pain catastrophizing, anxiety, and depression are important to consider, as they are associated with poorer outcomes and are potentially modifiable. The aim of this study was to assess the level of pain catastrophizing, anxiety, and depression in patients with a range of hip pathology and to evaluate their relationship with patient-reported psychosocial and functional outcome measures. Patients and Methods Patients presenting to a tertiary-centre specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, and depression. Validated assessments were undertaken such as: the Pain Catastrophizing Scale (PCS), the Hospital Anxiety Depression Scale (HADS), and the 12-Item Short-Form Health Survey (SF-12). Patient characteristics and demographics were also recorded. Multiple linear regression modelling, with adaptive least absolute shrinkage and selection operator (LASSO) variable selection, was used for analysis. Results A total of 328 patients were identified for inclusion, with diagnoses of hip dysplasia (DDH; n = 50), femoroacetabular impingement (FAI; n = 55), lateral trochanteric pain syndrome (LTP; n = 23), hip osteoarthrosis (OA; n = 184), and avascular necrosis of the hip (AVN; n = 16) with a mean age of 31.0 years (14 to 65), 38.5 years (18 to 64), 63.7 years (20 to 78), 63.5 years (18 to 91), and 39.4 years (18 to 71), respectively. The percentage of patients with abnormal levels of pain catastrophizing, anxiety, or depression was: 22.0%, 16.0%, and 12.0% for DDH, respectively; 9.1%, 10.9%, and 7.3% for FAI, respectively; 13.0%, 4.3%, and 4.3% for LTP, respectively; 21.7%, 11.4%, and 14.1% for OA, respectively; and 25.0%, 43.8%, and 6.3% for AVN, respectively. HADS Anxiety (HADSA) and Hip Disability Osteoarthritis Outcome Score Activities of Daily Living subscale (HOOS ADL) predicted the PCS total (adjusted R2 = 0.4599). Age, HADS Depression (HADSD), and PCS total predicted HADSA (adjusted R2 = 0.4985). Age, HADSA, patient’s percentage of perceived function, PCS total, and HOOS Quality of Life subscale (HOOS QOL) predicted HADSD (adjusted R2 = 0.5802). Conclusion Patients with hip pathology may exhibit significant pain catastrophizing, anxiety, and depression. Identifying these factors and understanding the impact of psychosocial function could help improve patient treatment outcomes. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Cite this article: Bone Joint J 2019;101-B:800–807.
Prospective triage and evidence-based transfusion practice education reduced unnecessary plasma and PLT transfusions and health care costs.
The primary linguistic theory of Shand and Klima (1981) hypothesizes that stimuli that cannot be directly processed without recoding are not in the primary linguistic mode of the subject and thus should lead to lesser recency and associated suffix effects. In three experiments, different normal hearing subjects learned to pair American Sign Language (ASL) stimuli, visual "quasivocables" (QVs), word-like letter strings, and auditory QVs with common English words. In the first experiment, the subjects were given sequences of ASL or QV stimuli and required to recall the associated words in strict serial order. In two other experiments involving auditory and visual presentation, respectively, subjects who had never been given paired associate training were required to recall the English words that had previously been associated with the ASL and QV stimuli, in a standard suffix paradigm. The results showed recency and suffix effects to be present only with auditorily presented QVs and words. Contrary to the predictions of the primary linguistic hypothesis, greater recency and larger suffix effects were present with the auditory QVs than with the auditory words, although the QVs were not primary linguistic and the task involved forced recoding. Previous results showing recency with ASL stimuli in normal subjects were not replicated. It is concluded that recency and suffix effects are not related either to the primary linguistic mode of the subject or to stimulus recoding, as we and Shand and Klima have defined them.
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