# Characterization of Tiered Psychological Distress Phenotypes in an Orthopaedic Sports Population

## TL;DR

This study identifies four psychological distress profiles in orthopaedic sports patients and shows how they relate to pain and depression outcomes.

## Contribution

The paper introduces a new framework for classifying psychological distress in orthopaedic sports patients using the OSPRO-YF tool.

## Key findings

- Four distinct psychological distress clusters were identified, with increasing distress levels from low to high.
- High distress patients reported significantly higher pain and depression scores compared to other groups.
- The framework may help guide targeted psychological treatments for orthopaedic sports patients.

## Abstract

Psychological distress and musculoskeletal pain are interconnected with poor functional outcomes. This study sought to classify common phenotypes of psychological distress in an orthopaedic sports population and assess differences in functional outcomes using the Prediction of Referral and Outcome (OSPRO-YF) tool. This was a cross-sectional study on 411 operative patients from a single sports surgeon’s clinical practice with completed OSPRO-YF questionnaires. Latent class analysis was employed to construct distress phenotypes based on binary measures for 11 single-construct psychological questionnaires, spanning two negative and one positive domains of pain-associated psychological distress. Functional outcome measures, including numerical pain scores, the Patient-Reported Outcomes Measurement Information System (PROMIS), the Single Assessment Numeric Evaluation (SANE) American Shoulder and Elbow Surgeons Score (ASES), and the International Knee Documentation Committee Subjective Knee Form (IKDC), were compared. Four psychological distress clusters were derived: low distress (LD-1; n = 111), low self-efficacy (LS-2; n = 101), negative pain coping, low self-efficacy (NP-3; n = 99), and high distress (HD-4; n = 100), with increasing yellow flags proceeding from LD-1 to HD-4. The mean numerical pain scores were highest in HD-4 and lowest in LD-1 and LS-2 (4.6 vs. 2.7 and 2.0, respectively; p < 0.001). The PROMIS depression scores were highest in HD-4 compared to NP-3, LS-2, and LD-1 (57.0 vs. 48.9 vs. 45.6 vs. 46.0; p < 0.001). Phenotyping patients based on OSPRO-YF distress indicators provides an initial framework of the psychological distress burdening the average orthopaedic sports surgical patient population and may aid in targeted psychological treatments.