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. 2023 Dec 30;6(1):100846.
doi: 10.1016/j.asmr.2023.100846. eCollection 2024 Feb.

Pain-Associated Psychological Distress Is of High Prevalence in Patients With Hip Pain: Characterizing Psychological Distress and Phenotypes

Grant H Cabell  1 , Nicholas F Kwon  2 , Kent F Sutton  3 , Trevor A Lentz  1   4 , Brian D Lewis  1 , Steven Olson  1 , Richard C Mather 3rd  1
Affiliations

Pain-Associated Psychological Distress Is of High Prevalence in Patients With Hip Pain: Characterizing Psychological Distress and Phenotypes

Grant H Cabell et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To identify common pain-related psychological factors among patients seeking care for athletic hip pain, as well as characterize psychological distress phenotypes and compare hip-specific quality-of-life measures across those phenotypes.

Methods: A total of 721 patients were recruited from hip preservation clinics. The Optimal Screening for Prediction of Referral and Outcome-Yellow Flag Assessment Tool (OSPRO-YF) was used to identify the presence or absence of 11 different pain-associated psychological distress characteristics (yellow flags), while the International Hip Outcome Tool-12 (iHOT-12) was used to assess hip-related quality of life. Latent class analysis identified patient subgroups (phenotypes) based on naturally occurring combinations of distress characteristics. An analysis of variance was used to compare demographics, number of yellow flags, and iHOT-12 scores across phenotypes.

Results: The median (interquartile range) number of yellow flags was 6 (3-9), with 13.5% of the sample reporting 11 yellow flags. Latent class analysis (L2 = 543.3, classification errors = 0.082) resulted in 4 phenotypes: high distress (n = 299, 41.5%), low distress (n = 172, 23.9%), low self-efficacy and acceptance (n = 74, 10.3%), and negative pain coping (n = 276, 24.4%). Significant differences in mean yellow flags existed between all phenotypes except low self-efficacy and negative pain coping. There were no differences in demographics between phenotypes. The high distress class had the lowest mean iHOT-12 score (mean [SD], 23.5 [17.6]), with significant differences found between each phenotypic class.

Conclusions: There was a high prevalence of pain-associated psychological distress in patients presenting to tertiary hip arthroscopy clinics with hip pain. Furthermore, hip quality-of-life outcome scores were uniformly lower in patients with higher levels of psychological distress.

Level of evidence: Level III, retrospective cohort study.

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Conflict of interest statement

The authors report the following potential conflicts of interest or sources of funding: B.D.L. is a paid consultant for both 10.13039/100008894Stryker and 10.13039/100006338Zimmer. R.C.M. is a board or committee member for the 10.13039/100008542Arthroscopy Association of North America and the North Carolina Orthopaedic Association. All other authors (G.H.C., N.F.K., K.F.S., T.A.L., S.O.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Figures

Fig 1
Fig 1
Total distribution of yellow flags as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool across our cohort.
Fig 2
Fig 2
The distribution of total yellow flags as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool in the fear avoidance domain across our cohort.
Fig 3
Fig 3
The distribution of total yellow flags in the positive affect/coping domain as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool across our cohort.
Fig 4
Fig 4
The distribution of total yellow flags in the negative mood domain as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool across our cohort.
Fig 5
Fig 5
The proportion of our sample with a yellow flag as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool in that specific construct.
Fig 6
Fig 6
The average International Hip Outcome Tool–12 score across each of the phenotypic classes in our 4-class model. ∗Error bars are 95% confidence intervals.
Fig 7
Fig 7
The average number of yellow flags as determined by the Optimal Screening for Prediction of Referral and Outcome–Yellow Flag Assessment Tool across each phenotypic class in our 4-class model. ∗Error bars are 95% confidence intervals.
See this image and copyright information in PMC

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