Predicting outcomes of total joint arthroplasty using the distress and risk assessment method

Psychological distress is presumed to be an important factor that can adversely impact the outcome of orthopaedic procedures. The Distress and Risk Assessment Method (DRAM) is an evaluation tool which assesses psychological distress in patients with low back pain. The purpose of this prospective study was to assess the influence of preoperative psychological distress, as determined by the DRAM score, on the functional outcomes of total joint arthroplasty (TJA).

A prospective study of 61 TJAs was performed at a single institution. The DRAM questionnaire and a variety of functional measures (12-Item Short Form Health Survey [SF-12], visual analogue scale [VAS], Oxford Hip Score [OHS], Oxford Knee Score [OKS], and Oswestry Disability Questionnaire [ODQ]) were administered to the patient at baseline, 1 month, and 6 months postoperatively. Mixed model regressions and Mann-Whitney tests were utilised to evaluate the relationship of the DRAM score with functional outcomes.

The summed quantitative DRAM score was predictive of functional outcomes. With each 1 point increase in psychological distress, VAS pain increased by 0.023 (p = 0.015), OKS decreased by 0.34 (p = 0.01), ODQ increased by 0.065 (p = 0.02), and MCS decreased by 0.14 (p = 0.015). In addition, patients with lower preoperative distress scores had higher rates of improvement than patients with higher preoperative distress scores for VAS pain (p = 0.034).

Psychological distress was associated with decreased baseline mental health and function in the early postoperative period, which has important implications for bundled payments. However, patients with psychological distress still demonstrated functional improvements and TJA should thus not be contraindicated in these patients.