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Extremities Feature

Source: Wikimedia and camdiluv

Harvard Unpacks Patient Happiness

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, April 2nd, 2018

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In the complicated world of orthopedics, Jon J.P. Warner, M.D. has led a team that examined something very fundamental…but not easy. Patient happiness.

Dr. Warner, chief of the Harvard Shoulder Service and director of the Boston Shoulder Institute Fellowship, recently presented his work at the annual meeting of the Academy of Orthopaedic Surgeons (AAOS).

Commenting on his work, “Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty,” which appeared in the June 21, 2017 edition of The Journal of Bone and Joint Surgery, Dr. Warner told OTW, “The shoulder is connected to a body…to a person who has hopes, dreams, and expectations. Orthopedic patients define the value of what we do by the life we give them back.

“We know that people walk around tolerating pain long before they sign on to have surgery. In reality their happiness is decaying over time—and it can be measured by the percentage of things they cannot do. So, we wondered, ‘If someone with arthritis comes to us and he or she is sad and full of anxiety, to what degree can we change their happiness using these measures from the realm of psychology.’’

“We enrolled 46 osteoarthritis patients who were about to undergo total shoulder arthroplasty (TSA).

All participants completed the Visual Analog Scale (VAS) for pain, the American Shoulder and Elbow Surgeons Scale (ASES), the Subjective Shoulder Value (SSV) measure, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF).”

“Our results indicated that TSA dramatically improved depression and anxiety scores, as well as overall attitude and optimism. It did not, however, improve patients’ social relationships.”

“I urge my colleagues not to discount patients taking antidepressants or anti-anxiety medications. There are several papers suggesting that these people have a negative prognostic outlook. Well, perhaps these are the ones we help the most…they are starting at such a low point and are going high, so you have a clinically meaningful difference.”

“As physicians the lens we use is different. We are accustomed to looking at the mechanical aspect of things. But happiness is fundamental and deserves to be further explored in the field of orthopedics.”

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