Functional improvement in hip pathology is related to improvement in anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being

Abstract

Background Pain catastrophizing, anxiety, and depression are risk factors for poor functional outcomes and worse post-treatment pain that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment. Methods Patients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes. Results A total of 201 patients (78 male, 123 female) with a mean age of 53.75 ± 18.97 years were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = − 0.373, p < 0.0001), depression (rs = − 0.363, p < 0.0001), and anxiety (rs = − 0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes. Conclusions Patients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Exploring this connection demonstrates the correlation between musculoskeletal impairment and psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care.

Digital Care Programs for Chronic Hip Pain: A Prospective Longitudinal Cohort Study

“…Current literature indicates that hip conditions are strongly associated with the patient’s levels of anxiety and depression [ 4 , 5 ]. Significant improvement in these two domains was observed after the DI, within a range (37–42%) greater than that previously reported both after in-person rehabilitation (28% to 29%) and telerehabilitation (6.3% to 35%) [ 31 , 32 ].…”

“…Hip pain is a common source of disability that increases with age, affecting one in five adults over 65 years old [ 1 ]. Over 18 million individuals report chronic hip symptoms in the United States (US) [ 2 ], which are associated with reduced functionality and quality of life, as well as with mental distress [ 3 , 4 , 5 ]. The weak correlation between abnormal structural findings and hip pain and/or disability prompted a shift towards a biopsychosocial model in the management of these conditions [ 6 , 7 ].…”

Patient perspectives of pain and function after knee replacement: a systematic review and meta-synthesis of qualitative studies

“… 43 Deficient patient and clinician relationships may also exacerbate mental health issues identified (themes 1 and 3), accentuating depression and anxiety, and possibly influencing pain catastrophising, all of which are known to have associations with pain severity 4 , 7 and suboptimal orthopaedic functional outcomes. 30 There has been minimal investigation of mental health issues in this population. With evidence for preexisting mental health issues and poor outcome following TKR, 56 , 59 and poor mental health remaining despite relative improvement in pain and function, 58 this suggests that a more collaborative and supportive approach between clinicians and their patients could also boost mental health and impact postoperative outcomes.…”

Depression in Osteoarthritis: Current Understanding

“…Because there is no gold standard for the definition and classification of psychological constructs, different researchers have different ways of delineating them, and the amount of information available on psychosocial factors is enormous, we only review the relevant variables selectively. The psychosocial factors that have received more attention in OA include perceived discrimination, 73 aesthetic discomfort, 74 pain catastrophizing, 75 social support, 76 perceived isolation, 77 social isolation, 78 and neighborhood characteristics. 79 Studies have been conducted to support the role of these psychological factors in the bidirectional relationship between OA and depression.…”