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J Knee Surg 2024; 37(06): 460-469
DOI: 10.1055/a-2179-3352
Original Article

Patient-Reported Outcome Measurement Information System Depression and Anxiety in Elective Knee Surgery Patients

Samir Kaveeshwar 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Matheus B. Schneider 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Justin E. Kung
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Tina Zhang 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Samuel Q. Li
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Natalie L. Leong 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Jonathan D. Packer
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Sean J. Meredith
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
R Frank Henn III 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations Funding This work was supported by a grant from The James Lawrence Kernan Hospital Endowment Fund, Incorporated (BL1941007WS). This work was supported in part by Career Development Award Number IK2 BX004879 from the United States (U.S.) Department of Veterans Affairs Biomedical Laboratory R&D (BLRD) Service.
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Abstract

Mental health has been shown to play an important role in patient-reported outcomes (PRO); however, there is a general lack of literature describing patient-reported outcome measurement information system (PROMIS) depression and anxiety computer adaptive tests in elective knee surgery patients. The purpose of our study was to assess the prevalence of depression and anxiety symptoms before and after elective knee surgery and to determine whether these symptoms influence postoperative functional outcomes. An institutional review board-approved prospective orthopaedic registry was retrospectively queried for patients undergoing elective knee surgery from June 2015 to November 2018. Electronic surveys collecting patient demographic information and PROs were administered pre- and postoperatively. Of the 663 patients that completed baseline questionnaires, 466 completed 2-year follow-up (70.3%). PROs included PROMIS depression, PROMIS anxiety, International Knee Documentation Committee Subjective Knee Form (IKDC), and PROMIS physical function (PF). Wilcoxon rank sum and Spearman's rank order correlation were utilized to determine associations between variables. Multivariable analysis was used to control for confounding variables. Average PROMIS depression and anxiety scores significantly improved 2 years after surgery. PROMIS depression and anxiety scores significantly correlated with each other. PROMIS depression and anxiety scores significantly correlated with PROMIS PF and IKDC scores. After controlling for confounders on multivariable analysis, worse 2-year PROMIS anxiety was predictive of less functional improvement and worse 2-year PF and IKDC, while worse 2-year PROMIS depression was predictive of less improvement in IKDC. This study confirms the important relationship between mental health and functional outcomes. Given that psychiatric comorbidities are potentially modifiable with treatment, proper recognition could potentially lead to better orthopaedic outcomes. In addition, the prevalence of depression and anxiety symptoms postoperatively, as documented by PROMIS computer adaptive tests, may act as a barrier to achieving optimal functional outcomes after elective knee surgery.

Level of Evidence Level III

Keywords

PROMIS - knee - depression - anxiety - patient-reported outcomes


Publication History

Received: 31 January 2022

Accepted: 20 September 2023

Accepted Manuscript online:
21 September 2023

Article published online:
30 October 2023

© 2023. Thieme. All rights reserved.

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