A reduction in perceived psychological distress over three years is associated with improvements in pain and symptoms in patients with longstanding hip and groin pain - a longitudinal prospective cohort study

Abstract Background Previous cross-sectional studies report an association between psychological distress and severity of pain and symptoms in patients with longstanding non-arthritic hip and groin pain (LHGP). However, there is a lack of longitudinal studies exploring changes in psychological distress over time, and whether these changes relate to changes in pain and symptoms in LGHP patients. This study aimed to assess any changes in patient-reported psychological distress in patients with LHGP from the time of referral to orthopedic care to a follow-up three years later. An additional aim was to explore the relationship between changes in psychological distress and changes in patient-reported pain and symptoms from baseline to the three-year follow-up. Methods Eighty-one patients who had previously participated in a cross-sectional study were invited for follow-up three years after their referral for orthopedic care due to LHGP. The Kessler Psychological Distress Scale (K-10) was used to assess psychological distress, and the subscales for pain and symptoms in the Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess pain and symptoms. The Wilcoxon signed-rank test was used for comparisons of K-10 scores from baseline to follow-up, and Spearman’s rank order correlation was used to examine the association between changes in K-10 scores and changes in HAGOS scores. Results Forty-five (56%) patients participated in the follow-up. No significant group-level change in the K-10 total score was found from baseline to the three-year follow-up (median change 0.0, IQR − 4.25; 4.25, p = 0.792). Significant improvements in the HAGOS subscales for pain (mean change 14.3, 95%CI 7.8;20.8) and symptoms (16.4, 95%CI 8.9;24.0) were reported ( p < 0.001). A moderate association was observed between changes in the K-10 total score and changes in the HAGOS subscale for pain (r s =-0.436, p = 0.004) and symptoms (r s =-0.431, p = 0.005) from baseline to the three-year follow-up. Conclusions Despite no significant group-level change in psychological distress, reductions in psychological distress were moderately associated with improvements in pain and symptom scores. The relationship between psychological distress and hip and groin pain and symptoms highlights the importance of considering both physical and psychological factors in patient management.