The importance of psychological health in musculoskeletal specialty care

The importance of psychological health in musculoskeletal specialty care

Orthopedic research has demonstrated that objective measures of pathology such as range of motion and the amount of joint space poorly predict patient-reported pain. Symptoms correlate more strongly with mental health and social well-being. This thesis aimed to elucidate how mental health impacts Orthopedic care. 

We used questionnaires distributed among people with various musculoskeletal diseases. Among patients with hand illness, we found that patients with greater depression and worse coping have more office visits and are more likely to undergo surgery. Surgical treatment did not adequately relieve symptoms of depression compared to nonoperative treatment. Among patients who had a placebo injection of the upper extremity, psychological factors were not predictive of the extent of the placebo effect. In patients with hip and knee arthritis, the combination of objective measures of disease and the amount of distress predicted the level of pain and functioning. The language that people use, as measured by a computer algorithm, did not predict patient levels of distress. When Orthopedic surgeons addressed mental health during an office visit, they did not receive lower ratings of patient-rated empathy. 

In conclusion, psychological health is an important factor that influences patient levels of pain and disability. Helping patients cope with pain through improving mental health can decrease the need for surgery and improve the value of care. Routine screening for mental health can help surgeons guide treatment decisions. Finally, surgeons can safely ask patients about the impact of musculoskeletal disease on mental health because it does not decrease patient satisfaction.

Dissertation: https://hdl.handle.net/11370/978bd3cd-2c55-4cfd-9082-fe8dd53b40ea