# Modification of Commonly Used Outcome Tools to Quantify the Patient Pain Distress Index Following Acute and Chronic Orthopedic Trauma

## TL;DR

This study introduces a new method to measure patient pain distress using existing tools, showing that higher distress is linked to worse recovery outcomes after orthopedic surgery.

## Contribution

A novel retrospective method to quantify the Pain Distress Index using existing PROMs without additional questionnaires.

## Key findings

- Higher Pain Distress Index levels correlated with significantly worse functional outcomes at 6 and 12 months post-surgery.
- The method can serve as a retrospective proxy for patient resilience in future research.
- Limited PDI was associated with poorer recovery, indicating its potential for identifying at-risk patients.

## Abstract

Introduction: Patient-reported outcome measures (PROMs) are an important component of evaluating patient health and are increasingly utilized in orthopedics. However, their use remains inconsistent among orthopedic subspecialties, with only 21% of orthopedic trauma surgeons reporting regular use of PROMs in their practice. While tools for quantifying patient distress in response to pain have been developed, they are often difficult to apply due to extensive questioning and the need for prospective implementation. The purpose of this study was to propose a novel retrospective technique to measure the Pain Distress Index (PDI) using two common PROMs: the visual analog scale (VAS) and the short musculoskeletal functional assessment (SMFA).

Methods: A total of 797 patients who underwent operative repair of a tibial plateau fracture or revision of long bone nonunion were included. To quantify PDI, a linear trend line was calculated from a scatter plot of SMFA Bothersome Index (BI) vs. VAS pain scores at three months postoperatively. Reported SMFA BI was compared to predicted SMFA BI, and patients were stratified into three cohorts: “limited,” “adequate,” and “excellent” PDI.

Results: In both cohorts, SMFA Function Index scores at 6 and 12 months postoperatively differed significantly among the limited, adequate, and excellent PDI levels (p < 0.0005, p < 0.0005). Worse PDI (indicating greater distress from pain) was associated with poorer SMFA Function Index scores.

Conclusions: The combination of SMFA BI and VAS scores may serve as a useful tool to quantify PDI without requiring an additional questionnaire. “Limited” PDI was associated with poorer functional outcomes at 6 and 12 months postoperatively. This method may help predict which patients are at risk for worse functional outcomes and could serve as a retrospective proxy for resilience in future research.