human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To specify what patients want and worry preoperatively is important in orthopedic practice . The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery  , and to evaluate the differences in expectations and concerns by age and gender . Methods We prospect ively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008 . Three question naires were completed before surgery : the first one addressing preoperative patient 's expectation , the second one focusing on concerns by covering 64 items using a visual analogue scale , and the third one evaluating patient 's demographic characteristics . The characteristics of preoperative  expectation , concern , and demographic data  were evaluated according to gender and age group . Results Female patients had lower level of sports activity ( p = 0.007 ) and lower levels of information ( p = 0.028 ) . Gender specific worries are about a caregiver during hospital stay , operating on the working side , fear about ugly scars , postoperative pain , applying makeup or combing hair . The older group responded that they ca n't be willing to change activities of daily living ( p = 0.001 ) , are not living with a spouse ( p = 0.002 ) , had previous shoulder operation history ( p = 0.008 ) , and had a lower level of information ( p = 0.007 ) . They especially worried about medical bills , worried about the physician being too young and inexperienced , postoperative pain , loss of arm function , and hospital food . Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery . This can empower patients to formulate realistic expectations and make informed decisions . We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine , but not for other anatomical regions . Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions . Design This was a prospect i ve , associational study . Methods Demographic , clinical ,  depressive symptom ( Symptom Checklist 90–Revised )  , and outcome data were collected by self-report from a convenience sample of 8,304 patients . Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables . An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status . Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes . Results Prevalence of severe depression  was higher in women , in industrial and pain clinics , and in patients who reported chronic pain or prior surgery . Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain .  Depressive symptoms had a moderate to large effect on pain ratings ( Cohen d=0.55–0.87 ) and a small to large effect on functional status ( Cohen d=0.28–0.95 ) . In multivariate analysis , depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations , except for discharge values for the cervical region . Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain . Depressive symptoms had a consistent detrimental influence on outcomes , except on discharge scores for the cervical anatomical region . Exp and ing screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy setting BACKGROUND To compare risk factors for shoulder pain without and with rotator cuff syndrome ( RCS ) . METHODS A total of 3,710 workers of a French region were r and omly included in the cross-sectional study between 2002 and 2005 .  Personal and occupational risk factors were assessed during a physical examination and by a self-administered question naire . Multinomial logistic modeling was used for the following outcomes : no shoulder pain and no RCS ( reference ) , shoulder pain without RCS ( called " shoulder pain " ) and RCS , separately for men and women . RESULTS The prevalence rates of " shoulder pain " for men and women were 28.0 % and 31.1 % , respectively , and the prevalence rates of RCS were 6.6 % and 8.5 % , respectively . In men , " shoulder pain " and RCS were associated with age , high-perceived physical exertion , and arm abduction . Automatic work pace and low supervisor support were associated with " shoulder pain , " and high psychological dem and and low skill discretion with RCS . In women , " shoulder pain " and RCS were associated with age , repetitiveness of tasks , and low supervisor support . High perceived physical exertion and exposure to cold temperatures were associated with " shoulder pain . " CONCLUSIONS Age was more strongly associated with RCS than with shoulder pain without RCS for both genders . Biomechanical and psychosocial factors were associated with " shoulder pain " and RCS and differed between genders Background Recently , psychological status , patient-centered outcomes , and health-related quality of life ( HRQoL ) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized . The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated . Questions / purpose sThe primary objective of this study was to investigate changes in psychological status ( depression , anxiety , insomnia ) and HRQoL after rotator cuff repair . The secondary objective was to assess whether preoperative depression , anxiety , and insomnia predict clinical outcome after rotator cuff repair . Methods Forty-seven patients who underwent rotator cuff repair prospect ively completed the  visual analog scale ( VAS ) pain score , the UCLA Scale , the  American Shoulder and Elbow Surgeons ’ Scale ( ASES ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pittsburgh Sleep Quality Index ( PSQI ) , and the World Health Organization Quality -of-life Scale Abbreviated Version ( WHOQOL-BREF ) before surgery and at 3 , 6 , and 12 months after surgery . Repeated- measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements . The chi-square test was also used to compare preoperative and postoperative prevalence of depression , anxiety , and insomnia . Finally , multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome . Results With surgery , depression , anxiety , and insomnia decreased , whereas quality of life increased . The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3 , 4.3 ± 4.3 , and 6.6 ± 3.6 , respectively , before surgery to 2.1 ± 2.3 , 1.4 ± 2.4 , and 4.2 ± 3.3 , respectively , at 12 months after surgery ( HADS-D mean difference 1.6 [ 95 % confidence interval { CI } , 0.6–2.6 ] , p = 0.003 ; HADS-A mean difference 2.9 [ 1.5–4.4 ] , p < 0.001 ; PSQI mean difference 2.4 [ 1.3–3.4 ] , p < 0.001 ) . The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery ( mean difference −7.0 [ 95 % CI , −10.7 to −3.4 ] , p < 0.001 ) . At 12 months after surgery , there were decreases in the prevalence of depression ( six of 47 [ 22.8 % ] versus three of 47 [ 6.4 % ] , p = 0.002 ) , anxiety ( 11 of 47 [ 23.4 % ] versus two of 47 [ 4.3 % ] , p = 0.016 ) , and insomnia ( 33 of 47 [ 70.2 % ] versus 20 of 47 [ 42.6 % ] , p = 0.022 ) . Preoperative HADS-depression , HADS-anxiety , and PSQI scores did not correlate with the VAS pain score , UCLA , or ASES scores at 12 months after surgery . Conclusions Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery . Preoperative depression , anxiety , and insomnia did not predict poor outcome after rotator cuff repair . Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL.Level of Evidence Level II , prospect i ve study Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self- assessment s of pain and function . In several other areas of orthopaedics , higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery . To our knowledge , the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated . Questions / purpose s(1 ) Are higher levels of preoperative psychological distress associated with differences in outcome scores ( visual analog scale [ VAS ] for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 2 ) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores ( VAS for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 3 ) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled ; 70 patients ( 82 % ) were assessed at 1-year followup . During the study period , the three participating surgeons performed 269  rotator cuff repairs ; in large part , the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study . Psychological distress was quantified using the Distress Risk Assessment Method question naire , and patients completed self- assessment s including the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair . Fifty of 85 patients ( 59 % ) had normal levels of distress , 26 of 85 ( 31 % ) had moderate levels of distress , and nine of 85 ( 11 % ) had severe levels of distress . Statistical models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function at 1 year after surgery . Results With the numbers available , distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain ( 1.9 [ 95 % confidence interval { CI } , 1.0–2.8 ] versus 1.0 [ 95 % CI , 0.5–1.4 ] , p = 0.10 ) , Simple Shoulder Test ( 9 [ 95 % CI , 8.1–10.4 ] versus 11 [ 95 % CI , 10.0–11.0 ] , p = 0.06 ) , or American Shoulder and Elbow Surgeons scores ( 80 [ 95 % CI , 72–88 ] versus 88 [ 95 % CI , 84–92 ] , p = 0.08 ) 1 year after arthroscopic rotator cuff repair . With the numbers available , distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain ( 3 [ 95 % CI , 2.2–4.1 ] versus 2 [ 95 % CI , 1.4–2.9 ] , p = 0.10 ) , Simple Shoulder Test ( 5.2 [ 95 % CI , 3.7–6.6 ] versus 5.0 [ 95 % CI , 4.2–5.8 ] , p = 0.86 ) , or American Shoulder and Elbow Surgeons scale ( 38 [ 95 % CI , 29–47 ] versus 30 [ 95 % CI , 25–36 ] , p = 0.16 ) . The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 ( 20 % ) versus 35 of 85 ( 41 % ) preoperatively ( odds ratio , 0.36 ; 95 % CI , 0.17–0.74 ; p = 0.005 ) . Conclusions Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinical ly important degree in this small series of patients with rotator cuff tears . This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status . Level of Evidence Level I , prognostic study OBJECTIVES This study assessed the prevalence , incidence , and persistence of nontraumatic rotator cuff tendinitis  and shoulder symptoms over a  
    Output:
    
agent
Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
However , these factors were not associated with patient-reported outcomes after intervention .
Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background To specify what patients want and worry preoperatively is important in orthopedic practice . The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery  , and to evaluate the differences in expectations and concerns by age and gender . Methods We prospect ively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008 . Three question naires were completed before surgery : the first one addressing preoperative patient 's expectation , the second one focusing on concerns by covering 64 items using a visual analogue scale , and the third one evaluating patient 's demographic characteristics . The characteristics of preoperative  expectation , concern , and demographic data  were evaluated according to gender and age group . Results Female patients had lower level of sports activity ( p = 0.007 ) and lower levels of information ( p = 0.028 ) . Gender specific worries are about a caregiver during hospital stay , operating on the working side , fear about ugly scars , postoperative pain , applying makeup or combing hair . The older group responded that they ca n't be willing to change activities of daily living ( p = 0.001 ) , are not living with a spouse ( p = 0.002 ) , had previous shoulder operation history ( p = 0.008 ) , and had a lower level of information ( p = 0.007 ) . They especially worried about medical bills , worried about the physician being too young and inexperienced , postoperative pain , loss of arm function , and hospital food . Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery . This can empower patients to formulate realistic expectations and make informed decisions . We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine , but not for other anatomical regions . Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions . Design This was a prospect i ve , associational study . Methods Demographic , clinical ,  depressive symptom ( Symptom Checklist 90–Revised )  , and outcome data were collected by self-report from a convenience sample of 8,304 patients . Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables . An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status . Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes . Results Prevalence of severe depression  was higher in women , in industrial and pain clinics , and in patients who reported chronic pain or prior surgery . Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain .  Depressive symptoms had a moderate to large effect on pain ratings ( Cohen d=0.55–0.87 ) and a small to large effect on functional status ( Cohen d=0.28–0.95 ) . In multivariate analysis , depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations , except for discharge values for the cervical region . Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain . Depressive symptoms had a consistent detrimental influence on outcomes , except on discharge scores for the cervical anatomical region . Exp and ing screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy setting BACKGROUND To compare risk factors for shoulder pain without and with rotator cuff syndrome ( RCS ) . METHODS A total of 3,710 workers of a French region were r and omly included in the cross-sectional study between 2002 and 2005 .  Personal and occupational risk factors were assessed during a physical examination and by a self-administered question naire . Multinomial logistic modeling was used for the following outcomes : no shoulder pain and no RCS ( reference ) , shoulder pain without RCS ( called " shoulder pain " ) and RCS , separately for men and women . RESULTS The prevalence rates of " shoulder pain " for men and women were 28.0 % and 31.1 % , respectively , and the prevalence rates of RCS were 6.6 % and 8.5 % , respectively . In men , " shoulder pain " and RCS were associated with age , high-perceived physical exertion , and arm abduction . Automatic work pace and low supervisor support were associated with " shoulder pain , " and high psychological dem and and low skill discretion with RCS . In women , " shoulder pain " and RCS were associated with age , repetitiveness of tasks , and low supervisor support . High perceived physical exertion and exposure to cold temperatures were associated with " shoulder pain . " CONCLUSIONS Age was more strongly associated with RCS than with shoulder pain without RCS for both genders . Biomechanical and psychosocial factors were associated with " shoulder pain " and RCS and differed between genders Background Recently , psychological status , patient-centered outcomes , and health-related quality of life ( HRQoL ) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized . The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated . Questions / purpose sThe primary objective of this study was to investigate changes in psychological status ( depression , anxiety , insomnia ) and HRQoL after rotator cuff repair . The secondary objective was to assess whether preoperative depression , anxiety , and insomnia predict clinical outcome after rotator cuff repair . Methods Forty-seven patients who underwent rotator cuff repair prospect ively completed the  visual analog scale ( VAS ) pain score , the UCLA Scale , the  American Shoulder and Elbow Surgeons ’ Scale ( ASES ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pittsburgh Sleep Quality Index ( PSQI ) , and the World Health Organization Quality -of-life Scale Abbreviated Version ( WHOQOL-BREF ) before surgery and at 3 , 6 , and 12 months after surgery . Repeated- measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements . The chi-square test was also used to compare preoperative and postoperative prevalence of depression , anxiety , and insomnia . Finally , multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome . Results With surgery , depression , anxiety , and insomnia decreased , whereas quality of life increased . The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3 , 4.3 ± 4.3 , and 6.6 ± 3.6 , respectively , before surgery to 2.1 ± 2.3 , 1.4 ± 2.4 , and 4.2 ± 3.3 , respectively , at 12 months after surgery ( HADS-D mean difference 1.6 [ 95 % confidence interval { CI } , 0.6–2.6 ] , p = 0.003 ; HADS-A mean difference 2.9 [ 1.5–4.4 ] , p < 0.001 ; PSQI mean difference 2.4 [ 1.3–3.4 ] , p < 0.001 ) . The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery ( mean difference −7.0 [ 95 % CI , −10.7 to −3.4 ] , p < 0.001 ) . At 12 months after surgery , there were decreases in the prevalence of depression ( six of 47 [ 22.8 % ] versus three of 47 [ 6.4 % ] , p = 0.002 ) , anxiety ( 11 of 47 [ 23.4 % ] versus two of 47 [ 4.3 % ] , p = 0.016 ) , and insomnia ( 33 of 47 [ 70.2 % ] versus 20 of 47 [ 42.6 % ] , p = 0.022 ) . Preoperative HADS-depression , HADS-anxiety , and PSQI scores did not correlate with the VAS pain score , UCLA , or ASES scores at 12 months after surgery . Conclusions Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery . Preoperative depression , anxiety , and insomnia did not predict poor outcome after rotator cuff repair . Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL.Level of Evidence Level II , prospect i ve study Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self- assessment s of pain and function . In several other areas of orthopaedics , higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery . To our knowledge , the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated . Questions / purpose s(1 ) Are higher levels of preoperative psychological distress associated with differences in outcome scores ( visual analog scale [ VAS ] for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 2 ) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores ( VAS for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 3 ) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled ; 70 patients ( 82 % ) were assessed at 1-year followup . During the study period , the three participating surgeons performed 269  rotator cuff repairs ; in large part , the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study . Psychological distress was quantified using the Distress Risk Assessment Method question naire , and patients completed self- assessment s including the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair . Fifty of 85 patients ( 59 % ) had normal levels of distress , 26 of 85 ( 31 % ) had moderate levels of distress , and nine of 85 ( 11 % ) had severe levels of distress . Statistical models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function at 1 year after surgery . Results With the numbers available , distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain ( 1.9 [ 95 % confidence interval { CI } , 1.0–2.8 ] versus 1.0 [ 95 % CI , 0.5–1.4 ] , p = 0.10 ) , Simple Shoulder Test ( 9 [ 95 % CI , 8.1–10.4 ] versus 11 [ 95 % CI , 10.0–11.0 ] , p = 0.06 ) , or American Shoulder and Elbow Surgeons scores ( 80 [ 95 % CI , 72–88 ] versus 88 [ 95 % CI , 84–92 ] , p = 0.08 ) 1 year after arthroscopic rotator cuff repair . With the numbers available , distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain ( 3 [ 95 % CI , 2.2–4.1 ] versus 2 [ 95 % CI , 1.4–2.9 ] , p = 0.10 ) , Simple Shoulder Test ( 5.2 [ 95 % CI , 3.7–6.6 ] versus 5.0 [ 95 % CI , 4.2–5.8 ] , p = 0.86 ) , or American Shoulder and Elbow Surgeons scale ( 38 [ 95 % CI , 29–47 ] versus 30 [ 95 % CI , 25–36 ] , p = 0.16 ) . The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 ( 20 % ) versus 35 of 85 ( 41 % ) preoperatively ( odds ratio , 0.36 ; 95 % CI , 0.17–0.74 ; p = 0.005 ) . Conclusions Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinical ly important degree in this small series of patients with rotator cuff tears . This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status . Level of Evidence Level I , prognostic study OBJECTIVES This study assessed the prevalence , incidence , and persistence of nontraumatic rotator cuff tendinitis  and shoulder symptoms over a  
    Output:
    