Effects of Anxiety and Depression Measured via the Hospital Anxiety and Depression Scale on Early Pain and Range of Motion After Rotator Cuff Repair

Abstract

Background: Preoperative anxiety and depression are independent predictors of clinical outcomes after arthroscopic rotator cuff repair. However, few studies have evaluated correlations between outcomes such as pain and range of motion (ROM) after arthroscopic rotator cuff repair and preoperative anxiety and depression. Purpose: To evaluate the effects of preoperative anxiety and depression, measured using the Hospital Anxiety and Depression Scale (HADS), on early pain and ROM after rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 144 consecutive patients who underwent arthroscopic rotator cuff repair were enrolled and divided into 2 groups according to HADS scores: group A, those with a healthy psychological status (n = 103; anxiety <= 7 and depression <= 7), and group B, those with psychological distress (n = 41; anxiety >= 8 or depression >= 8). Clinical outcomes were assessed using the visual analog scale for pain (pVAS) and ROM at 3 and 6 months postoperatively and annually. Results: There were no significant preoperative differences in age, sex, tear size, pVAS scores, and ROM. However, at 3 months postoperatively, group A showed significantly lower mean pVAS scores (2.2 +/- 1.3 vs 3.4 +/- 1.8, respectively; P = .001) and significantly higher mean forward flexion (146.4 degrees +/- 23.0 degrees vs 124.1 degrees +/- 28.2 degrees, respectively; P < .001) than group B, as well as significantly higher mean levels of internal rotation at the back (T11.5 +/- 2.8 vs L1.9 +/- 2.5, respectively; P < .001) and significantly higher mean external rotation (42.4 degrees +/- 15.9 degrees vs 35.2 degrees +/- 16.8 degrees, respectively; P = .019). At 6 months postoperatively, the mean pVAS score was still significantly lower in group A than in group B (0.8 +/- 1.6 vs 1.8 +/- 2.1, respectively; P = .016), but other ROM measurements had no significant differences. There was also no significant difference in clinical and functional outcomes at the final follow-up. Conclusion: Anxiety and depression negatively affected clinical outcomes after rotator cuff repair. Recovery from pain and of ROM after arthroscopic rotator cuff repair occurred more quickly in patients with a healthy psychological status. Therefore, assessments of preoperative psychological status should be emphasized to improve early clinical outcomes after arthroscopic rotator cuff repair.