Effect of anxiety and depression on early pain and range of motion after rotator cuff repair - measured by HADS (Hospital Anxiety and Depression Scale) -

OBJECTIVES: According to previous studies, the prevalence of anxiety and depression was approximately 25% in patients with rotator cuff tear, and psychological status may be an important predictor for clinical outcomes after rotator cuff repair. Considering continuous steady rehabilitation is essential for recovery of postoperative pain and range of motion (ROM), the anxiety or depression would affect this process. The aim of this study was to evaluate the effect of anxiety and depression measured by HADS (Hospital Anxiety and Depression Scale) on early pain and ROM after rotator cuff repair. METHODS: Consecutive 156 patients who underwent arthroscopic rotator cuff repair were prospectively enrolled, and divided into two groups defined by HADS scores; Group I with normal psychological status (n = 105, anxiety ≤ 7 and depression ≤ 7), Group II with psychological distress (n = 51, anxiety ≥ 8 or depression ≥ 8). Same rehabilitation protocols were applied to all patients: 4 ˜ 6 weeks of brace according to tear size, and then ROM exercises. Clinical outcomes were measured with pain VAS and ROM at 3, 6 months and 1 year after surgery. RESULTS: There were no significant differences in age, cuff tear size, preoperative external and internal rotation angle between two groups, but more female patients, higher preoperative pain VAS, and lower range of preoperative forward flexion in Group II (all p < 0.05). At 3 months after surgery, the average of pain VAS was 2.2 ± 1.3 in Group I, which was statistically lower than 3.5 ± 2.0 in Group II. The average forward flexion was 145.4° ± 23.4° in Group I, and 122.5° ± 30.3° in Group II. The average external rotation was 42.3° ± 16.1° in Group I, and 34.7° ± 17.6° in Group II. The mean level of internal rotation at back was T11.6 ± 2.8 in Group I, and L1.9 ± 2.4 in Group II (all p < 0.05). At 6 months after surgery, there was no significant difference in forward flexion (148.9° ± 23.2° in Group I compared with 144.9° ± 25.2° in Group II) and external rotation (59.5° ± 13.4° in Group I compared with 54.5° ± 17.5° in Group II). The mean level of internal rotation at back was T9.4 ± 1.8 in Group I, and T10.0 ± 1.5 in Group II (p < 0.05). The average of pain VAS was 0.8 ± 1.6 in Group I, which was statistically lower than 1.6 ± 2.0 in Group II (p < 0.05). However, there was no significant difference in ROM and pain VAS at 1 year after surgery. CONCLUSION: The recovery of pain and ROM was faster in patients with normal psychological status after arthroscopic rotator cuff repair. Therefore, psychologic intervention including medication should be collaborated to improve early clinical outcomes after rotator cuff repair through the encouragement of rehabilitation, as well as mitigation of anxiety and depression moods.