Does the SF-36 Mental Health Composite Score Predict Functional Outcome after Surgery in Patients with End Stage Ankle Arthritis?

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1 Does the SF-36 Mental Health Composite Score Predict Functional Outcome after Surgery in Patients with End Stage Ankle Arthritis? Kennedy SA, Barske H, Penner M, Daniels T, Glazebrook M, Wing K, Dryden P, Wong H, and Younger A.

2 Does the SF-36 Mental Health Composite Score Predict Functional Outcome after Surgery in Patients with End Stage Ankle Arthritis? Kennedy SA, Barske H, Penner M, Daniels T, Glazebrook M, Wing K, Dryden P, Wong H, and Younger A. Our disclosures are in the Final AOFAS Mobile App. We have no potential conflict with this presentation

3 Background: Depression may be the strongest predictor of health status across chronic health conditions across disease conditions and cultures Moussavi et al. Lancet (2007) vol. 370 (9590) pp Treating depression in patients with knee OA significantly improves knee pain, function, and quality of life. Lin et al. JAMA (2003)

4 Purpose: To assess whether the MCS predicts change in AOS after surgery for End Stage Ankle Arthritis

5 Methods: Study type: Observational cohort from existing multicenter database Population: COFAS database. Average 5.1 years follow-up. Minimum 3.5 years. Instruments: SF-36 (PCS and MCS), Ankle Osteoarthritis Scale (AOS). Higher MCS - Better mental health status Higher AOS - Greater ankle disability Statistics: Regression analysis

6 351 ankles Results: 99 arthrodeses and 252 arthroplasties Mean follow-up of 5.3+/- 1.2 years No significant correlation between preop MCS score and change in AOS score from baseline to final postop follow-up (R 2 = 0.005) Weak correlation between preoperative MCS and preoperative AOS scores (R2=0.01, P<0.05).

7 Results: Total Cohort N=351 Arthrodesis N=99 Ankle replacement N=252 Mean (SD 1 ) followup, years 5.1 (1.4) 5.0 (1.2) 5.2 (1.5) Male sex, n (%) 198 (56%) 61 (62%) 137 (54%) Mean (SD) age, years 61 +(12) 54 (12) 64 (11) Mean (SD) BMI 2, kg/m 2 28 (5) 29 (6) 28 (5) Mean (SD) AOS 3 total score / / / Mean (SD) MCS 4 score (SF-36) / / / Mean (SD) PCS 5 score (SF-36) / / /- 7.4 Poorer mental health status than hip and knee OA

8 Results: There was no difference between patients who had MCS <50 or MCS >50, in terms of change in AOS after surgery MCS < 50 MCS > 50 Sample Size: Mean improvement in AOS total score Mean improvement in AOS pain score Mean improvement in AOS disability score

9 Results: There was a small correlation between between MCS and AOS for a given time period (i.e. at baseline or at follow-up) Baseline association pre-op MCS and AOS was R 2 =0.01, p<0.05 Post-operative association was R 2 =0.03, p<0.0005

10 Conclusion: In patients with end-stage ankle arthritis preoperative mental-health status (as measured by MCS score) did not predict improvement of outcome at intermediateterm postoperative follow-up. AOS scores improved in all patients Consistent with other studies indicating that current mental-health status influences perception of outcome, there was a slight correlation between MCS and AOS scores prior to surgery

11 References: 1. Moussavi S; Chatterji S; Verdes E; Tandon A; Patel V; Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet Sep 8;370(9590): Lin EH, Katon W, Von Korff M, Tang L, Williams JW Jr, Kroenke K, Hunkeler E, Harpole L, Hegel M, Arean P, Hoffing M, Della Penna R, Langston C, Unützer J. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized control trial. JAMA. 2003;290(18): Vissers MM; Bussmann JB; Verhaar JA; Busschbach JJ; Bierma-Zeinstra SM; Reijman M. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum Feb;41(4): Domsic RT; Saltzman CL. Ankle osteoarthritis scale. Foot Ankle Int. 1998;19(7): Ware JE, Jr.; Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care Jun;30(6): Patel AA; Donegan D; Albert T. The 36-item short form. J Am Acad Orthop Surg Feb;15(2): Friedman B; Heisel M; Delavan R. Validity of the SF-36 five-item Mental Health Index for major depression in functionally impaired, community-dwelling elderly patients. J Am Geriatr Soc Nov;53(11): Madeley NJ; Wing KJ; Topliss C; Penner MJ; Glazebrook MA; Younger AS. Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int Jan;33(1): Ayers DC; Franklin PD; Trief PM; Ploutz-Snyder R; Freund D. Psychological attributes of preoperative total joint replacement patients: implications for optimal physical outcome. J Arthroplasty Oct;19(7 Suppl 2):

Disclosures. The authors disclosures are in the Final AOFAS Mobile App. The authors may have a potential conflict with this presentation due to:

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