51
|
Abstract
The intensity of pain reported for a given nociception is highly variable. Variation in pain intensity is best accounted for by stress, distress, and ineffective coping strategies. Among orthopedic surgery patients, greater intake of opioids is associated with greater pain intensity and decreased satisfaction with pain control, no matter the pathophysiology or nociception. The single most effective pain reliever is self-efficacy (the sense that one can manage and that everything will be okay).
Collapse
Affiliation(s)
- Mariano E Menendez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA 02114, USA
| | - David Ring
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA 02114, USA.
| |
Collapse
|
52
|
One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress. Clin Orthop Relat Res 2015; 473:3501-10. [PMID: 26293222 PMCID: PMC4586226 DOI: 10.1007/s11999-015-4513-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments 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/PURPOSES (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 prospectively 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 questionnaire, and patients completed self-assessments 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 clinically 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.
Collapse
|
53
|
Kennedy SA. CORR Insights(®): To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients With Hand Fractures? Clin Orthop Relat Res 2015; 473:3491-3. [PMID: 25894810 PMCID: PMC4586208 DOI: 10.1007/s11999-015-4296-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Stephen Alan Kennedy
- Department of Orthopaedics and Sports Medicine, University of Washington, 4245 Roosevelt Way NE, Box 354740, Seattle, WA, 98105, USA.
| |
Collapse
|
54
|
Associations between Distal Upper Extremity Job Physical Factors and Psychosocial Measures in a Pooled Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:643192. [PMID: 26557686 PMCID: PMC4628736 DOI: 10.1155/2015/643192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/10/2015] [Indexed: 11/24/2022]
Abstract
Introduction. There is an increasing body of literature relating musculoskeletal diseases to both job physical exposures and psychosocial outcomes. Relationships between job physical exposure measures and psychosocial factors have not been well examined or quantified. These exploratory analyses evaluate relationships between quantified exposures and psychosocial outcomes. Methods. Individualized quantification of duration, repetition, and force and composite scores of the Strain Index (SI) and the Threshold Limit Value for Hand Activity Level (TLV for HAL) were compared to 10 psychosocial measures. Relationships and predicted probabilities were assessed using ordered logistic regression. Analyses were adjusted for age, BMI, and gender. Results and Discussion. Among 1834 study participants there were multiple statistically significant relationships. In general, as duration, repetition, and force increased, psychosocial factors worsened. However, general health and mental exhaustion improved with increasing job exposures. Depression was most strongly associated with increased repetition, while physical exhaustion was most strongly associated with increased force. SI and TLV for HAL were significantly related to multiple psychosocial factors. These relationships persisted after adjustment for strong confounders. Conclusion. This study quantified multiple associations between job physical exposures and occupational and nonoccupational psychosocial factors. Further research is needed to quantify the impacts on occupational health outcomes.
Collapse
|
55
|
Bekkers S, Becker SJE, Bossen JKJ, Mudgal CS, Ring D, Vranceanu AM. Relationships between pain misconceptions, disability, patients' goals and interpretation of information from hand therapists. J Hand Ther 2015; 27:287-94; quiz 295. [PMID: 25064147 DOI: 10.1016/j.jht.2014.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/27/2014] [Accepted: 06/12/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patient interpretation of advice from hand therapists may be related to nonadaptive pain thoughts (automatic, overprotective, unduly pessimistic statements triggered by nociception and exacerbated by psychological distress). PURPOSE OF THE STUDY This study aimed to determine whether there were correlations between participants' hand therapy goals, interpretation of advice from hand therapists, nonadaptive pain thoughts, and upper extremity-specific disability. METHODS One hundred and five participants completed questionnaires assessing nonadaptive pain thoughts, upper extremity-specific disability, lessons from hand therapists, and hand therapy goals. RESULTS Nonadaptive pain thoughts correlated with disability and were bi-directionally related to participant goals and interpretation of advice from hand therapists. DISCUSSION Patients' nonadapative pain thoughts and the words/concepts used by hand therapists are both important in recovery from upper extremity illness. CONCLUSIONS Hand therapists should be mindful that nonadaptive pain thoughts are an important determinant of disability and that such thoughts can affect and be affected by their recommendations. LEVEL OF EVIDENCE n/a.
Collapse
Affiliation(s)
- Stijn Bekkers
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Stéphanie J E Becker
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jeroen K J Bossen
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chaitanya S Mudgal
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David Ring
- Department of Orthopaedic Surgery, Harvard Medical School, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Harvard Medical School, Behavioral Medicine Service, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
56
|
Filipova V, Lonzarić D, Jesenšek Papež B. Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial. Wien Klin Wochenschr 2015; 127 Suppl 5:S282-7. [DOI: 10.1007/s00508-015-0812-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
|
57
|
Janssen SJ, ter Meulen DP, Nota SP, Hageman MG, Ring D. Does Verbal and Nonverbal Communication of Pain Correlate With Disability? PSYCHOSOMATICS 2015; 56:338-44. [DOI: 10.1016/j.psym.2014.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/15/2022]
|
58
|
Abstract
Background Finger stiffness varies substantially in patients with hand and upper extremity illness and can be notably more than expected for a given pathophysiology. In prior studies, pain intensity and magnitude of disability consistently correlate with coping strategies such as catastrophic thinking and kinesiophobia, which can be characterized as overprotectiveness. In this retrospective study we address the primary research question whether patients with finger stiffness are more often overprotective when the primary pathology is outside the hand (e.g. distal radius fracture) than when it is located within the hand. Methods In an orthopaedic hand surgery department 160 patients diagnosed with more finger stiffness than expected for a given pathophysiology or time point of recovery between December 2006 and September 2012 were analyzed to compare the proportion of patients characterized as overprotective for differences by site of pathology: (1) inside the hand, (2) outside the hand, and (3) psychiatric etiology (e.g. clenched fist). Results Among 160 subjects with more finger stiffness than expected, 132 (82 %) were characterized as overprotective including 88 of 108 (81 %) with pathology in the hand, 39 of 44 (89 %) with pathology outside the hand, and 5 of 8 (63 %) with psychiatric etiology. These differences were not significant. Conclusions Overprotectiveness is common in patients with more finger stiffness than expected regardless the site and type of primary pathology. It seems worthwhile to recognize and treat maladaptive coping strategies early during recovery to limit impairment, symptoms, and disability.
Collapse
|
59
|
Wojtkiewicz DM, Saunders J, Domeshek L, Novak CB, Kaskutas V, Mackinnon SE. Social impact of peripheral nerve injuries. Hand (N Y) 2015; 10:161-7. [PMID: 26034424 PMCID: PMC4447662 DOI: 10.1007/s11552-014-9692-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorders involving the peripheral nervous system can have devastating impacts on patients' daily functions and routines. There is a lack of consideration of the impact of injury on social/emotional well-being and function. METHODS We performed a retrospective database and chart review of adult patients presenting between 2010 and 2012 with peripheral nerve compression, brachial plexus injury, thoracic outlet syndrome (TOS), or neuromas. At the initial assessment, patients completed a questionnaire used to obtain demographic and psychosocial variable data including the (1) average level of pain over the last month, (2) self-perceived depression, (3) how much pain impacts quality of life (QoL), (4) current level of stress, and (5) ability to cope with stress. Statistical analyses were used to assess the differences between the dependent variables and diagnostic and demographic groups. RESULTS This study included 490 patients (mean age 50 ± 15 years); the most common diagnosis was single nerve compression (n = 171). Impact on QoL was significantly greater in patients with TOS, cutaneous peroneal compressions, and neuroma versus single site nerve compressions. Average pain, impact on QoL, and stress at home were significantly higher in females versus males. Impact on QoL was correlated with average pain, depression, stress at home, and ability to cope with stress at home. CONCLUSIONS Our study demonstrates that patients with single site nerve compression neuropathies experience fewer negative psychosocial effects compared to patients with more proximal upper extremity peripheral nerve disorders and neuromas. The impact on QoL was strongly correlated with pain and depression, where patients with neuromas and painful peroneal nerve entrapments reported greater detriments to QoL.
Collapse
Affiliation(s)
- Danielle M. Wojtkiewicz
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - James Saunders
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Leahthan Domeshek
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| | - Christine B. Novak
- />Hand and Upper Extremity Program, Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON Canada
| | - Vicki Kaskutas
- />Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO USA
| | - Susan E. Mackinnon
- />Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Suite 1150, Northwest Tower, 660 South Euclid Avenue, Campus Box 8238, St. Louis, MO 63110 USA
| |
Collapse
|
60
|
Menendez ME, Eberlin KR, Mudgal CS, Ring D. Language barriers in Hispanic patients: relation to upper-extremity disability. Hand (N Y) 2015; 10:279-84. [PMID: 26034444 PMCID: PMC4447666 DOI: 10.1007/s11552-014-9697-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient's primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients. METHODS A total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed. RESULTS Spanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient's primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r = -0.35; p < 0.001) with disability in English-speaking patients, while the correlation was large (r = -0.52; p < 0.001) in Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r = -0.66; p < 0.001; English-speaking: r = -0.77; p < 0.001). The length of time since immigration to the USA did not correlate with disability among Spanish speakers. CONCLUSION Primary language has less influence on symptom intensity and magnitude of disability than psychological distress and ineffective coping strategies. Interventions to optimize mood and to reduce pain interference should be considered in patients of all nationalities. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Mariano E. Menendez
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Kyle R. Eberlin
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Chaitanya S. Mudgal
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
61
|
A threshold disability score corresponds with an estimated diagnosis of clinical depression in patients with upper extremity disease. Hand (N Y) 2015; 10:168-72. [PMID: 26034425 PMCID: PMC4447652 DOI: 10.1007/s11552-014-9686-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this study was to assess whether there is a threshold Disability of Arm, Shoulder and Hand (DASH) score among patients with common hand diagnoses that corresponds with an estimated diagnosis of clinical depression. METHODS Two hundred sixty-nine patients with one of five common upper extremity disorders completed a measure of upper extremity-specific disability (QuickDASH or DASH) and a questionnaire assessing depressive symptoms (Patient Health Questionnaire (PHQ) or Center for Epidemiologic Studies Depression scale (CES-D). A receiver operating characteristic (ROC) analysis of the discriminatory value of a threshold DASH score for an estimated diagnosis of clinical depression was assessed. The threshold DASH score with the highest positive predictive value for an estimated diagnosis of clinical depression was selected. In bivariate analysis, the association between demographic factors, disease factors, and an estimated diagnosis of clinical depression was examined. RESULTS The area under the ROC curve for a threshold DASH value diagnostic of an estimated diagnosis of clinical depression was 0.75, indicating clinical usefulness for a threshold DASH score as a screening test for depression. The highest positive predictive value of 72 % occurred at a threshold QuickDASH/DASH score of 55. In bivariate analysis, only diagnosis and years of education were significantly different between patients with and without an estimated diagnosis of clinical depression. CONCLUSION A DASH score of 55 or greater in patients with common upper extremity disorders has an acceptable area under the curve and positive predictive value for an estimated diagnosis of clinical depression. LEVEL OF EVIDENCE Level 3, diagnostic study.
Collapse
|
62
|
Menendez ME, Thornton E, Kent S, Kalajian T, Ring D. A prospective randomized clinical trial of prescription of full-time versus as-desired splint wear for de Quervain tendinopathy. INTERNATIONAL ORTHOPAEDICS 2015; 39:1563-9. [PMID: 25916954 DOI: 10.1007/s00264-015-2779-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/25/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE There is no consensus on the best protocol for splint wear in the non-operative management of de Quervain tendinopathy. This study aimed to determine if there is a difference between prescription of strict splint wear compared to selective splint wear in patients with de Quervain tendinopathy. We tested the primary null hypothesis that there is no difference in upper-extremity disability eight weeks after initiating splinting between patients prescribed full-time or as-desired splint wear. Secondary study questions addressed differences in grip strength, pain intensity, and treatment satisfaction. Additionally, we evaluated the influence of psychological factors on disability. METHODS Eighty-three patients diagnosed with de Quervain tendinopathy were randomly allocated into two different splint-wearing instructions: full-time wear (N = 43) or as-desired wear (N = 40). At enrollment, patients had grip strength measured and completed measures of upper-extremity disability, pain intensity, and psychological distress. An average of 7.5 weeks later, patients returned for a second visit. Analysis was by intention-to-treat and with use of mean imputation for missing data. RESULTS Fifty-eight patients (70 %; 26 in the full-time cohort and 32 in the as-desired cohort) completed the study. There were no statistically significant differences in disability (p = 0.77), grip strength (p = 0.82), pain intensity (p = 0.36), and treatment satisfaction (p = 0.91) between patients instructed to wear the splint full-time and those instructed to use it as desired. Disability at final evaluation correlated significantly with baseline levels of pain anxiety (p = 0.008), catastrophic thinking (p = 0.001), and symptoms of depression (p < 0.001). The best multivariable linear regression model included symptoms of depression alone and accounted for 32 % of the variability in disability (p < 0.001). CONCLUSION There is no difference in patient-reported outcomes and grip strength with prescription of full-time or as-desired splinting, and patients can wear the splint as they prefer. These results suggest that splinting for de Quervain tendinopathy is palliative at best and strict rest is not disease modifying.
Collapse
Affiliation(s)
- Mariano E Menendez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA, 02114, USA,
| | | | | | | | | |
Collapse
|
63
|
Overbeek CL, Nota SPFT, Jayakumar P, Hageman MG, Ring D. The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness. Clin Orthop Relat Res 2015; 473:311-7. [PMID: 25099262 PMCID: PMC4390943 DOI: 10.1007/s11999-014-3840-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/22/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). QUESTIONS/PURPOSES We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. METHODS A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. RESULTS There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r=-0.55, p<0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r=-0.35, p<0.001 and r=0.34, p<0.001 respectively) and Pain Interference (r=-0.51, p<0.001 and r=0.74, p<0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is not. CONCLUSIONS The PROMIS Physical Function instrument may be used as an upper extremity disability measure, as it correlates with the QuickDASH questionnaire, and both instruments are influenced most strongly by the degree to which pain interferes with achieving goals. LEVEL OF EVIDENCE Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Celeste L. Overbeek
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Sjoerd P. F. T. Nota
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Prakash Jayakumar
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Michiel G. Hageman
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - David Ring
- />The Hand and Upper Extremity Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- />Orthopaedic Associates, Yawkey Center for Outpatient Care, Suite 2C, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
64
|
Roh YH, Lee BK, Baek JR, Noh JH, Gong HS, Baek GH. A randomized comparison of volar plate and external fixation for intra-articular distal radius fractures. J Hand Surg Am 2015; 40:34-41. [PMID: 25446409 DOI: 10.1016/j.jhsa.2014.09.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare surgical outcomes of volar locking plates (VP) and external fixation (EF) (with or without intra-focal fixation) for AO-type C2 and C3 fractures of the distal radius. METHODS From an initial group of 92 patients with AO-type C2 and C3 distal radius fractures who were enrolled in a prospective, randomized study comparing volar plate fixation with external fixation (with or without intra-focal fixation), 74 patients were studied. The researchers evaluated functional assessments (wrist range of motion, grip strength, and Michigan Hand Questionnaire) at each patient visit and measured radiographic assessment (radial inclination, volar tilt, ulnar variance, and articular congruity) at 12 months. RESULTS The grip strength of the VP group was significantly greater than that of the EF group at 3 and 6 months. The range of motion was significantly greater in the VP group than in the EF group at 3 months. There were no significant differences in the range of motion and grip strength between the 2 groups at 12 months. The Michigan Hand Questionnaire score was higher in the VP group than in the EF group at 3 months but was same at 12 months. There was no significant difference between groups with respect to volar tilt or radial inclination. The VP group showed superior radiologic outcomes in terms of the ulnar variance. One patient in the VP group and 3 in the EF group had an intra-articular stepoff deformity greater than 2 mm. This difference did not reach statistical significance. CONCLUSIONS These results for functional recovery after distal radius surgery offer insight into treatment decisions and interpretations of treatment outcomes for patients with comminuted intra-articular distal radius fractures.
Collapse
Affiliation(s)
- Young Hak Roh
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Beom Koo Lee
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Ryoon Baek
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ho Noh
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon; Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon-si, Gangwon-do; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
65
|
Potter MQ, Wylie JD, Greis PE, Burks RT, Tashjian RZ. Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears. Clin Orthop Relat Res 2014; 472:3926-32. [PMID: 25080266 PMCID: PMC4397768 DOI: 10.1007/s11999-014-3833-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. QUESTIONS/PURPOSES This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? METHODS Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. RESULTS Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p = 0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p = 0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p < 0.001). Distress remained associated with higher VAS scores (p = 0.001) and lower Simple Shoulder Test (p < 0.001) and American Shoulder and Elbow Surgeons scores (p < 0.001) when age, sex, BMI, American Society of Anesthesiologists classification, smoking status, tear size, and tear retraction were controlled. CONCLUSIONS Higher levels of psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michael Q. Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - James D. Wylie
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Patrick E. Greis
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert T. Burks
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert Z. Tashjian
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| |
Collapse
|
66
|
Mayland EC, Hay-Smith EJ, Treharne GJ. Recovery-related anxiety and disability following upper limb injury: the importance of context. Disabil Rehabil 2014; 37:1753-9. [DOI: 10.3109/09638288.2014.976719] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
67
|
Management of intolerance to casting the upper extremities in claustrophobic patients. ScientificWorldJournal 2014; 2014:803047. [PMID: 25379544 PMCID: PMC4213395 DOI: 10.1155/2014/803047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/10/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully.
Collapse
|
68
|
Constantinou L, Cobb TK, Walden AL. Long-term follow-up of osteochondral autologous transplantation in the metacarpophalangeal joints. Hand (N Y) 2014; 9:335-9. [PMID: 25191164 PMCID: PMC4152430 DOI: 10.1007/s11552-013-9596-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Louis Constantinou
- />Department of Clinical Research, Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
| | - Tyson K. Cobb
- />Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
| | - Anna L. Walden
- />Department of Clinical Research, Orthopaedic Specialists, Inc, 3385 Dexter Ct., Davenport, IA 52807 USA
| |
Collapse
|
69
|
Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Factors delaying recovery after volar plate fixation of distal radius fractures. J Hand Surg Am 2014; 39:1465-70. [PMID: 24908556 DOI: 10.1016/j.jhsa.2014.04.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the factors influencing delayed functional recovery in patients with a distal radius fracture treated by volar plate fixation. METHODS A total of 122 patients with a distal radius fracture treated by volar locking plate were enrolled. The wrist range of motion, grip strength, and functional outcome by the Michigan hand score were assessed 3, 6, and 12 months after surgery. The factors assessed for their influence on delayed functional recovery include age, sex, bone mineral density (BMD), hand dominance, the type of fracture, the energy of trauma, the time to surgery, and the duration of immobilization. A multivariate regression analysis was conducted to identify independent predictors of delayed functional recovery in terms of the Michigan hand score. RESULTS There was a significant decrease in the wrist range of motion in patients with a high-energy trauma, severe type fracture, or increase in duration of immobilization at month 3, whereas only a severe fracture type was associated with a decreased range of motion after 6 and 12 months. An increase in age, a decrease in BMD, and high-energy trauma reduced grip strength at months 3 and 6, whereas only an increase in age and a decrease in BMD reduced grip strength at month 12. According to the multivariate regression analysis, severe type fracture and high-energy trauma reduced functional outcomes at months 3 and 6. Conversely, at month 12, an increase in age and a decrease in BMD reduced functional outcome. CONCLUSIONS An increase in age and a decrease in BMD were important risk factors influencing delayed functional recovery up to 12 months after distal radius fracture surgery, whereas fracture severity and high-energy trauma were associated with decreased functional outcomes up to 6 months after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
70
|
Potter MQ, Wylie JD, Sun GS, Beckmann JT, Aoki SK. Psychologic distress reduces preoperative self-assessment scores in femoroacetabular impingement patients. Clin Orthop Relat Res 2014; 472:1886-92. [PMID: 24574122 PMCID: PMC4016432 DOI: 10.1007/s11999-014-3531-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/13/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In several areas of orthopaedics, including spine and upper extremity surgery, patients with greater levels of psychologic distress report worse self-assessments of pain and function than patients who are not distressed. This effect can lead to lower than expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychologic component. QUESTIONS/PURPOSES The purposes of this study were to determine (1) the association of psychologic distress and baseline modified Harris hip scores and Hip Outcome Scores in patients undergoing hip arthroscopy; and (2) whether psychologic distress would remain a significant negative predictor of baseline hip scores when other clinical variables such as age, sex, BMI, smoking status, and American Society of Anesthesiologists (ASA) classification were controlled. METHODS One hundred forty-seven patients at one center were prospectively enrolled when they scheduled hip arthroscopy to treat painful femoroacetabular impingement. Before surgery, psychologic distress was quantified using the Distress Risk Assessment Method questionnaire. Patients also completed baseline self-assessments of hip pain and function including the modified Harris hip score and the Hip Outcome Score. Age, sex, BMI, smoking status, and ASA classification were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychologic distress on patient self-assessment of hip pain and function. RESULTS Patients with distress reported significantly lower baseline modified Harris hip scores (58 versus 67, p = 0.001), Hip Outcome Score-Activities of Daily Living scores (62 versus 72, p = 0.002), and Hip Outcome Score-Sports scores (36 versus 47, p = 0.02). Distress remained significantly associated with lower baseline modified Harris hip (p = 0.006), Hip Outcome Score-Activities of Daily Living (p = 0.005), and Hip Outcome Score-Sports scores (p = 0.017) when age, sex, BMI, smoking status, and ASA classification were controlled for in the multivariate model. CONCLUSIONS Practitioners should recognize that psychologic distress has a negative correlation with baseline patient self-assessment using the modified Harris hip score and the Hip Outcome Scores, scales not previously described to correlate with psychologic distress. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes in patients having hip arthroscopy. LEVEL OF EVIDENCE Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Michael Q. Potter
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - James D. Wylie
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Grant S. Sun
- />University of Utah School of Medicine, Salt Lake City, UT USA
| | - James T. Beckmann
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Stephen K. Aoki
- />Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| |
Collapse
|
71
|
London DA, Stepan JG, Boyer MI, Calfee RP. The impact of depression and pain catastrophization on initial presentation and treatment outcomes for atraumatic hand conditions. J Bone Joint Surg Am 2014; 96:806-14. [PMID: 24875021 PMCID: PMC4018773 DOI: 10.2106/jbjs.m.00755] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prior studies have suggested that patient-rated hand function is impacted by depression and pain catastrophization. We studied the impact that these comorbidities have on treatment outcomes. METHODS Two hundred and fifty-six patients presenting to an orthopaedic hand clinic were followed in this prospective cohort investigation. Patients who were prescribed treatment for atraumatic hand/wrist conditions were eligible for inclusion. At enrollment, all patients completed the Center for Epidemiologic Studies Depression (CES-D) scale, the Pain Catastrophizing Scale (PCS), and the Michigan Hand Outcomes Questionnaire (MHQ; scale of 0 to 100, with 100 indicating the best hand performance). One month and three months after treatment, patients again completed the MHQ. Participants' psychological comorbidity status was categorized as either affected (a CES-D score of ≥16, indicating depression, or a PCS score of ≥30, indicating catastrophization) or unaffected (a CES-D score of <16 and a PCS score of <30). Diagnoses and treatments for both the affected and unaffected groups were examined. The effect of time and patient status, and their interaction, on MHQ scores was evaluated by mixed modeling. RESULTS Fifty patients were categorized as affected and 206 as unaffected. Diagnoses and treatments differed minimally between the two groups. At the time of enrollment, the mean MHQ score of the unaffected group (64.9; 95% confidence interval [CI], 62.5 to 67.3) was significantly higher than that of the affected group (48.1; 95% CI, 43.3 to 53.0). Both groups demonstrated similar significant absolute improvement over baseline at three months after treatment (an increase of 12.5 points [95% CI, 7.5 to 17.4] in the affected group and 12.8 points [95% CI, 10.4 to 15.3] in the unaffected group). Thus, at the time of final follow-up, the rating of hand function by the affected patients (60.6 [95% CI, 55.0 to 66.2]) was still significantly poorer than the rating by the unaffected patients (77.7 [95% CI, 75.0 to 80.5]). CONCLUSIONS Although patients affected by depression and/or pain catastrophization reported worse self-rated hand function at baseline and at the time of follow-up, these patients showed similar absolute improvement in self-rated hand function following treatment compared with patients with unaffected status. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Daniel A. London
- Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for R.P. Calfee:
| | - Jeffrey G. Stepan
- Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for R.P. Calfee:
| | - Martin I. Boyer
- Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for R.P. Calfee:
| | - Ryan P. Calfee
- Washington University, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for R.P. Calfee:
| |
Collapse
|
72
|
Bot AGJ, Menendez ME, Neuhaus V, Ring D. The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:519-27. [PMID: 24630546 DOI: 10.1016/j.jse.2013.12.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Psychiatric comorbidity has been associated with increased health risks and poor long-term treatment outcomes in numerous medical disciplines, but its effect in short-term perioperative settings is incompletely understood. The purpose of this study was to evaluate the influence of a preoperative diagnosis of depressive disorder, anxiety disorder, schizophrenia, or dementia on in-hospital (1) adverse events, (2) blood transfusion, and (3) nonroutine discharge in patients undergoing shoulder arthroplasty. METHODS Using the National Hospital Discharge Survey (NHDS) database, we identified 348,824 discharges having undergone partial or total shoulder arthroplasty from 1990 to 2007. Multivariable regression analysis was performed for each of the outcome variables. RESULTS The prevalence of diagnosed depressive disorder was 4.4%, anxiety disorder, 1.6%; schizophrenia, 0.6%; and dementia, 1.5%. Preoperative psychiatric disorders, with the exception of schizophrenia, were associated with higher rates of adverse events. Depression and schizophrenia were associated with higher perioperative rates of blood transfusion. Any preoperative psychiatric illness was associated with higher rates of nonroutine discharge. CONCLUSIONS Patients with preoperative psychiatric illness undergoing shoulder arthroplasty are at increased risk for perioperative morbidity and posthospitalization care. Preoperative screening of psychiatric illness might help with planning of shoulder arthroplasty.
Collapse
Affiliation(s)
- Arjan G J Bot
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Mariano E Menendez
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Valentin Neuhaus
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
73
|
Abstract
BACKGROUND Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture. METHODS A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12 months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured. RESULTS Complete demographic and 12-month follow-up data were available on 227 patients (75 %). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score. CONCLUSIONS Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.
Collapse
|
74
|
Abstract
BACKGROUND Patient expressions reflect disability and psychological factors. The aim of this study was to list common phrases and feelings in hand surgery practice and to prospectively study the correlation of these phrases and to correlate them with possible associated feelings and disability. METHODS Eighty-three patients completed the short version of the disabilities of arm, shoulder and hand (QuickDASH) questionnaire to measure disability, the pain self-efficacy questionnaire (PSEQ) to study coping, and a pain scale. The patients also completed the phrases and feelings questionnaire, which list verbal expressions patients often use. Pearson's correlation was used to test the correlation of continuous variables, and independent t test and one-way ANOVA were used for categorical variables. All variables with p < 0.08 were inserted in a multivariable regression. RESULTS There was a large correlation between the individual phrases and feelings questions with PSEQ and QuickDASH. The best model for the combined phrases questionnaire included pain, PSEQ, smoking, and other pain conditions. The best model for the combination of all the feelings questions included PSEQ, pain, and marital status. The best model for QuickDASH included phrases, PSEQ, prior treatment, and working status, with phrases being the strongest factor. CONCLUSIONS Patients use specific phrases that indicate the magnitude of their disability and the effectiveness of their coping strategies. Providers should respond to these phrases by empathetically acknowledging these aspects of the human illness experience.
Collapse
|
75
|
Bot AGJ, Bekkers S, Herndon JH, Mudgal CS, Jupiter JB, Ring D. Determinants of disability after proximal interphalangeal joint sprain or dislocation. PSYCHOSOMATICS 2014; 55:595-601. [PMID: 25034813 DOI: 10.1016/j.psym.2014.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sprain or dislocation of the proximal interphalangeal joint may be a useful example of the counterintuitive aspects of recovery as the prognosis is excellent, but protectiveness in response to discomfort often hinders the stretching exercises that are a key component of the recovery process. OBJECTIVE The aim of this study was to investigate the relationship between disability and pain self-efficacy in this context. METHODS A total of 82 patients (54 men and 28 women) were enrolled in this prospective study. Finger motion was measured, and the patients completed measures of upper limb-specific disability (the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire), symptoms of depression (Patient Health Questionnaire-9), effective coping strategies in response to pain (the Pain Self-Efficacy Questionnaire), and a pain scale at enrollment. RESULTS Patients were enrolled a mean of 48 days after injury. The final multivariable model accounting for greater disability included lower self-efficacy, greater symptoms of depression, and gender (women have more disability). Lower self-efficacy was also the strongest predictor of pain intensity and finger stiffness. CONCLUSIONS Effective coping strategies such as self-efficacy facilitate recovery (less disability, pain, and stiffness) after proximal interphalangeal joint sprain/dislocation. LEVEL OF EVIDENCE Prognostic level I.
Collapse
Affiliation(s)
| | | | | | | | | | - David Ring
- Massachusetts General Hospital, Boston, MA
| |
Collapse
|
76
|
Abbreviated psychologic questionnaires are valid in patients with hand conditions. Clin Orthop Relat Res 2013; 471:4037-44. [PMID: 23913341 PMCID: PMC3825874 DOI: 10.1007/s11999-013-3213-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/25/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Pain Catastrophizing Scale (PCS) and Short Health Anxiety Inventory (SHAI) can help hand surgeons identify opportunities for psychologic support, but they are time consuming. If easier-to-use tools were available and valid, they might be widely adopted. QUESTIONS/PURPOSES We tested the validity of shorter versions of the PCS and SHAI, the PCS-4 and the SHAI-5, by assessing: (1) the difference in mean scaled scores of the short and long questionnaires; (2) floor and ceiling effects between the short and long questionnaires; (3) correlation between the short questionnaires and the outcome measures (an indication of construct validity); and (4) variability in disability and pain, between the short and long questionnaires. METHODS One hundred sixty-four new or followup adult patients in one hand surgery clinic completed the SHAI-18, SHAI-5, PCS-13, PCS-4, Patient Health Questionnaire (PHQ)-9, PHQ-2, DASH, and QuickDASH questionnaires, and an ordinal pain scale, as part of a prospective cross-sectional study. Mean scores for the short and long questionnaires were compared with paired t-tests. Floor and ceiling effects were calculated. Pearson's correlation was used to assess the correlation between the short and long questionnaires and with outcome measures. Regression analyses were performed to find predictors of pain and disability. RESULTS There were small, but significant differences between the mean scores for the DASH and QuickDASH (QuickDASH higher), SHAI-18 and SHAI-5 (SHAI-18 higher), and PCS-13 and PCS-4 (PCS-4 higher), but not the PHQ-9 and PHQ-2. Floor effects ranged between 0% and 65% and ceiling effects between 0% and 3%. There were greater floor effects for the PHQ-2 than for the PHQ-9, but floor and ceiling effects were otherwise comparable for the other short and long questionnaires. All questionnaires showed convergent and divergent validity and criterion validity was shown in multivariable analyses. CONCLUSIONS Content validity, construct convergent validity, and criterion validity were established for the short versions of the PCS and SHAI. Using shorter forms creates small differences in mean values that we believe are unlikely to affect study results and are more efficient and advantageous because of the decreased responder burden.
Collapse
|
77
|
Roh YH. Clinical evaluation of upper limb function: Patient's impairment, disability and health-related quality of life. J Exerc Rehabil 2013; 9:400-5. [PMID: 24278892 PMCID: PMC3836539 DOI: 10.12965/jer.130060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 01/22/2023] Open
Abstract
Musculoskeletal disorders substantially impacts physical activity, mental state, and quality of life (QOL). Generally, comprehensive assessment of upper limb function requires measures of impairment or disability as well as health-related quality of life. A growing number of outcome instrument have been introduced to evaluate upper limb function and disability, and these measures can be categorized as patient- or clinician-based, and as condition specific or general health-related QOL evaluations. The upper limb outcome instruments reviewed in this article assess different aspect of upper limb conditions, and the measures are affected by differences in cultural, psychological, and gender aspect of illness perception and behavior. Therefore, physician should select/interpret the outcome instruments addressing their primary purpose of research. Information about regional instruments for upper limb condition and health-related QOL in upper limb disorder may help us in decision-making for treatment priority or in interpretation of the treatment outcomes.
Collapse
Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| |
Collapse
|
78
|
Ayers DC, Franklin PD, Ring DC. The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues. J Bone Joint Surg Am 2013; 95:e165. [PMID: 24196477 PMCID: PMC3808180 DOI: 10.2106/jbjs.l.00799] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David C. Ayers
- The Arthritis and Joint Replacement Center, Department of
Orthopaedics and Physical Rehabilitation, UMass Memorial Medical Center, 119 Belmont
Street, Worcester, MA 01605
| | - Patricia D. Franklin
- Department of Orthopedics and Physical Rehabilitation,
University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA
01655
| | - David C. Ring
- Department of Orthopaedic Surgery, MGH Orthopaedic Hand
& Upper Extremity Service, Massachusetts General Hospital, Yawkey Center 2100,
55 Fruit Street, Boston, MA 02114. E-mail address:
| |
Collapse
|
79
|
|
80
|
Abstract
PURPOSE Pain is not a classical symptom of carpal tunnel syndrome (CTS), with the exception of numbness that is so intense that it is described by patients as painful. The primary aim of our study was to determine which factors correlated with pain for patients diagnosed with CTS. METHODS We prospectively assessed all patients diagnosed with CTS in our unit over a 1-year period. We recorded demographic details for all patients, including past medical history, body mass index, smoking, and occupation. The diagnosis and severity of carpal tunnel syndrome were established through a combination of history, clinical assessment, and nerve conduction studies. Of 275 patients diagnosed and treated for CTS, 183 were women (67%), the mean age was 55 years (range, 22-87 y), and 166 cases were bilateral (60%). The mean body mass index was 29.5 kg/m2 (range, 17-48 kg/m2), and 81 patients smoked (30%). Patients completed a Short Form-McGill pain questionnaire (SF-MPQ) as a measure of pain at initial presentation. We assessed outcome 1 year after intervention using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. RESULTS We found no association between pain according to the SF-MPQ and the positive clinical signs of CTS or positive nerve conduction studies. Multivariate analysis demonstrated that smoking and bilateral disease independently correlated with the overall SF-MPQ, with similar findings on subanalysis. Independent factors associated with an increased improvement in the QuickDASH at 1 year were the presentation QuickDASH score, positive nerve conduction studies, and smoking. CONCLUSIONS The only independent factors that correlated with pain at presentation of CTS were smoking and bilateral disease. Pain according to the SF-MPQ was not associated with classical clinical findings of the disease or with positive findings on nerve conduction testing. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
Collapse
|
81
|
Becker SJE, Bot AGJ, Curley SE, Jupiter JB, Ring D. A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis. Osteoarthritis Cartilage 2013; 21:668-75. [PMID: 23458785 DOI: 10.1016/j.joca.2013.02.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/02/2013] [Accepted: 02/19/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In patients with trapeziometacarpal arthrosis, we tested the hypothesis that there is no difference in arm-specific disability 5-15 weeks after prescription of a pre-fabricated neoprene or a custom-made thermoplast hand-based thumb spica splint with the metacarpophalangeal joint included and the first interphalangeal joint free. METHOD One hundred nineteen patients with a diagnosis of trapeziometacarpal arthrosis were prospectively randomized to wear either a neoprene or a thermoplast hand-based thumb spica splint. At enrollment, patients completed a set of validated questionnaires. An average of 9 weeks later, patients returned for a second visit. Bivariable analyses assessed factors associated with disability, pain and satisfaction. Analysis was by intention-to-treat. RESULTS Sixty-two patients (32 with a neoprene and 30 with a thermoplast splint) completed the study, 51 patients (43%) did not return for the second visit, and six did not complete the protocol for other reasons. Non-completers were significantly younger than completers (P < 0.00044). On average completers rated the neoprene splint as more comfortable (P = 0.048), but there were no detectable differences in Disabilities of the Arm, Shoulder and Hand (DASH), change in DASH, pain, satisfaction, pinch or grip strength between the two splint types in our sample. CONCLUSION When compared to custom-made thermoplast splints, pre-fabricated neoprene hand-based thumb spica splints are, on average, more comfortable, less expensive, and as effective in treating trapeziometacarpal arthrosis. This trial was registered at Clinicaltrials.gov (NCT00438763).
Collapse
Affiliation(s)
- S J E Becker
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | | | |
Collapse
|
82
|
Cho CH, Jung SW, Park JY, Song KS, Yu KI. Is shoulder pain for three months or longer correlated with depression, anxiety, and sleep disturbance? J Shoulder Elbow Surg 2013; 22:222-8. [PMID: 22738644 DOI: 10.1016/j.jse.2012.04.001] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/26/2012] [Accepted: 04/01/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies have found a high prevalence of depression, anxiety, and sleep disturbance in patients with chronic musculoskeletal pain. We conducted a study to determine whether shoulder pain for 3 months or longer is correlated with depression, anxiety, and sleep disturbance. MATERIALS AND METHODS We prospectively evaluated 130 patients who had had shoulder pain for 3 months or longer (group I) and 60 healthy controls (group II). We obtained visual analog scale (VAS) pain score, and scores for the American Shoulder and Elbow Surgeons (ASES), Korean Shoulder Scale (KSS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI). RESULTS The mean VAS pain score, ASES score, and KSS score in group I were 6.2, 46.6, and 51.5, respectively. In that group, 22.3% had depression, 19.2% had anxiety, and 81.5% had sleep disturbance. The prevalences were higher in group I than in group II. There were no differences in depression, anxiety, or sleep disturbance by age, sex, type of disease, or duration of symptoms in group I. VAS pain scores positively correlated with PSQI scores (P = .01). ASES and KSS scores negatively correlated with HADS depression and anxiety subscale and PSQI scores (P < .001). Shoulder pain for 3 months or longer was the strongest predictor of sleep disturbance (P < .001). CONCLUSIONS Our study demonstrated high prevalence and close relationships of depression, anxiety, and sleep disturbance in patients with shoulder pain for 3 months or longer. These results may indicate importance of the psychologic approach as well as adequate pain control.
Collapse
Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea
| | | | | | | | | |
Collapse
|
83
|
Abstract
Complex distal radius fractures are high-energy injuries of the wrist with articular disruption, ligamentous instability, significant comminution, soft tissue injury, and/or neurovascular impairment. The management of these injuries requires a thorough understanding of wrist functional anatomy and familiarity with a wide selection of approach and fixation options. This article reviews an approach that involves structured evaluation, aggressive soft tissue management, early reduction and skeletal stabilization, and a columnar approach to definitive care. Outcome is determined by multiple factors and depends greatly on the soft tissue injury, patient factors, and management and the adequacy of restoration of osseous and ligamentous relationships.
Collapse
Affiliation(s)
- Stephen A Kennedy
- Hand and Microvascular Surgery, Department of Orthopaedics and Sports Medicine, University of Washington-Roosevelt II, Seattle, WA 98105, USA
| | | |
Collapse
|
84
|
To what degree do shoulder outcome instruments reflect patients' psychologic distress? Clin Orthop Relat Res 2012; 470:3470-7. [PMID: 22907473 PMCID: PMC3492603 DOI: 10.1007/s11999-012-2503-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 06/29/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychologic distress contributes to symptom severity in patients with several musculoskeletal disorders. While numerous shoulder outcome instruments are used it is unclear whether and to what degree psychologic distress contributes to the scores. QUESTIONS/PURPOSES We asked (1) to what degree shoulder outcome instruments reflect patients' psychologic distress, and (2) whether patients who are strongly affected by psychologic distress can be identified. METHODS We prospectively evaluated 119 patients with chronic shoulder pain caused by degenerative or inflammatory disorders using the Constant-Murley scale, Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. To evaluate psychologic distress, we measured depression using the Center for Epidemiologic Studies-Depression (CES-D) scale and pain anxiety using the Pain Anxiety Symptom Scale (PASS). Demographic and clinical parameters, such as pain scores, ROM, and abduction strength, also were measured. We then assessed the relative contributions made by psychologic distress and other clinical parameters to the quantitative ratings of the three shoulder outcome instruments. RESULTS Quantitative ratings of shoulder outcome instruments correlated differently with psychologic distress. Constant-Murley scores did not correlate with psychologic measures, whereas SST scores correlated with PASS (r = 0.32) and DASH scores correlated with PASS and CES-D (r = 0.36 and r = 0.32). Psychologic distress contributed to worsening SST and DASH scores but not to Constant-Murley scores. DASH scores were more strongly influenced by pain anxiety and depression than the other two outcome instruments. CONCLUSIONS Shoulder outcome measures reflected different psychologic aspects of illness behavior, and the contributions made by psychologic distress to different shoulder outcome instruments apparently differed. Physicians should select and interpret the findings of shoulder outcome instruments properly by considering their psychologic implications. LEVEL OF EVIDENCE Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
85
|
Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain. Arch Orthop Trauma Surg 2012; 132:1251-7. [PMID: 22609976 DOI: 10.1007/s00402-012-1545-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Indexed: 02/09/2023]
Abstract
BACKGROUND Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability. METHODS In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH). RESULTS DASH scores were found to be moderately correlated (0.3 < r < 0.6) with ROM, strength, pain VAS and CES-D; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion (r = 0.58; p < 0.001, 0.37; p < 0.001, 0.32; p = 0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance. CONCLUSIONS Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Level 2, prospective cohort study, prognostic study.
Collapse
|
86
|
Determinants of patient satisfaction after orthopedic interventions to the hand: a review of the literature. J Hand Ther 2012; 24:303-12.e10; quiz 312. [PMID: 21684112 DOI: 10.1016/j.jht.2011.04.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 04/07/2011] [Accepted: 04/09/2011] [Indexed: 02/03/2023]
Abstract
UNLABELLED Treatment effectiveness is increasingly evaluated from the patients' perspective. However, the interpretation of satisfaction is complex because the patient's perception of a satisfactory outcome is influenced by numerous factors. The objective of this study was to identify which factors are associated with patient satisfaction after orthopedic interventions to the hand. A literature review was conducted, including studies on determinants of satisfaction with treatment outcome or unspecified overall satisfaction of patients with hand problems. The results indicate that patient satisfaction is determined by multiple factors. There is moderate evidence that pain/symptoms, activities of daily living/function, aesthetics, and embodiment influence patient satisfaction. Furthermore, data indicate a correlation of strength, range of motion, fulfillment of expectations, deformity, workers' compensation, and length of follow-up with satisfaction. Knowledge about these determinants may lead to a more detailed decision-making process, thus contributing to improved treatment outcomes and cost-effectiveness. LEVEL OF EVIDENCE V.
Collapse
|
87
|
Gong HS, Lee JO, Huh JK, Oh JH, Kim SH, Baek GH. Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation. Injury 2011; 42:1266-70. [PMID: 21310409 DOI: 10.1016/j.injury.2011.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/27/2010] [Accepted: 01/04/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with orthopaedic trauma experience substantial psychological and physical morbidities. The purpose of this study was to assess depressive symptoms in patients with a distal radius fracture, and to determine whether early use of the wrist after volar plating reduces depressive symptoms as compared with cast immobilisation during the early recovery period. MATERIALS AND METHODS Twenty-six patients with a distal radius fracture, who underwent volar plating and were allowed immediate use of the wrist, and 24 patients treated by cast immobilisation for 6 weeks were prospectively compared with respect to depressive symptoms at week 0, and at 2, 6, 12 and 24 weeks after injury, using the Center for Epidemiologic Studies Depression Scale (CES-D). Physical morbidity was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a pain Numerical Rating Scale (NRS). Multivariate analysis was performed to identify factors that independently predicted CES-D scores at each time point. RESULTS No differences in the CES-D scores were found between the volar plating and the cast immobilisation groups, although volar plating group had marginally better CES-D scores at 24 weeks. Multivariate analysis indicated that CES-D scores at each time were independently associated with pain NRS scores at 0 and 24 weeks, and DASH scores at 6 weeks. CONCLUSION Early use of the wrist after volar plating was not found to reduce depressive symptoms as compared with cast immobilisation in the early treatment period following a distal radius fracture. Pain was found to be an important predictor of depression, suggesting that caution is needed to address pain during the early rehabilitation period.
Collapse
Affiliation(s)
- Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Goomi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
| | | | | | | | | | | |
Collapse
|
88
|
Chronic psychological and functional sequelae after emergent hand surgery. J Hand Surg Am 2011; 36:1663-8. [PMID: 21862240 DOI: 10.1016/j.jhsa.2011.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Several studies have shown that upper extremity trauma has serious, acute psychological effects after injury. This study's goal was to assess the psychological outcomes, including symptoms of major depression, posttraumatic stress disorder (PTSD), and other psychosocial variables, as well as the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) results, after severe hand trauma. We hypothesized that hand trauma would have persistent psychological sequelae long after the physical injury. METHODS We performed a cross-sectional survey of 34 patients who had emergency hand surgery at a Level 1 trauma center an average of 16 months (range, 7-32 mo) earlier. The hand disability measure was the QuickDASH, and the psychological measures included the Center for Epidemiologic Studies Depression Scale, the Screen for Posttraumatic Stress Symptoms, the Medical Outcomes Study Social Support Survey Form, the Social Constraints Survey (to assess interpersonal stressors), and the Perceived Stress Scale. RESULTS The overall QuickDASH score was 27. The mean score for PTSD was 13 (above the clinical threshold for PTSD), and 29% of respondents had high levels of both depression and PTSD. High pain scores on the QuickDASH were strongly correlated with both depression and PTSD symptoms. CONCLUSIONS This study found high levels of psychological distress in patients after hand trauma. Hand disability was strongly related to pain, depression, and PTSD symptoms. This study shows that the psychological sequelae of hand trauma can persist long after the physical injury. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
|
89
|
Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord 2011; 12:139. [PMID: 21711512 PMCID: PMC3146907 DOI: 10.1186/1471-2474-12-139] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 06/28/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. METHODS An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. RESULTS MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most prevalent in the infraspinatus (77%) and the upper trapezius muscles (58%), whereas latent MTrPs were most prevalent in the teres major (49%) and anterior deltoid muscles (38%). The number of muscles with active MTrPs was only moderately correlated with the DASH score. CONCLUSION The prevalence of muscles containing active and latent MTrPs in a sample of patients with chronic non-traumatic shoulder pain was high.
Collapse
Affiliation(s)
- Carel Bron
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
90
|
Kim JK, Kim YK. Predictors of scar pain after open carpal tunnel release. J Hand Surg Am 2011; 36:1042-6. [PMID: 21636023 DOI: 10.1016/j.jhsa.2011.03.036] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the predictors of scar pain after open carpal tunnel release (CTR). METHODS We enrolled 83 patients with idiopathic carpal tunnel syndrome treated by open CTR. All patients completed the Brigham and Women's (Boston) carpal tunnel questionnaire (BCTQ) preoperatively. We assessed levels of depression preoperatively using the Center for the Epidemiological Study of Depression (CES-D) scale, and pain anxiety using the Pain Anxiety Symptoms Scale. At 3 months after surgery, patients were asked to self-assess treatment satisfaction and scar pain using a 10-point ordinal scale and to complete the BCTQ. RESULTS The mean BCTQ-symptom (BCTQ-S) score decreased significantly from 2.7 ± 1.1 preoperatively to 1.6 ± 1.0 at 3 months postoperatively, and mean BCTQ-function score decreased significantly from 2.4 ± 1.1 to 1.4 ± 1.0. Overall, scar pain intensity at 3 months postoperatively ranged from 0 to 8 (mean, 2.4 ± 2.2), and overall satisfaction ranged from 2 to 10 (mean, 7.6 ± 2.6). The intensity of the scar pain was significantly correlated with the CES-D scale and BCTQ-S. Multivariable regression analysis showed that depression, assessed using the CES-D scale, and postoperative symptoms, assessed using the BCTQ-S, predicted scar pain intensity, which accounted for 38% of scar pain intensity variance. CONCLUSIONS Depression score and postoperative symptoms predicted scar pain intensity after open CTR. However, the most important contributor to scar pain intensity variance remains unidentified. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
Collapse
Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Ewha Womans University, Seoul, South Korea.
| | | |
Collapse
|
91
|
Squitieri L, Reichert H, Kim HM, Chung KC. Application of the brief international classification of functioning, disability, and health core set as a conceptual model in distal radius fractures. J Hand Surg Am 2010; 35:1795-1805.e1. [PMID: 20934818 PMCID: PMC4413476 DOI: 10.1016/j.jhsa.2010.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 05/27/2010] [Accepted: 07/06/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE In 2009, the World Health Organization published a conceptual outcome framework for evaluating upper extremity injury and disease, known as the Brief International Classification of Functioning, Disability, and Health (ICF) Core Set for Hand Conditions. The purpose of this study was to apply the ICF conceptual model to outcomes for distal radius fractures (DRFs) and determine the contribution of each ICF domain to patient satisfaction. METHODS Patient-rated and objective functional outcome data were collected at 6 weeks, 3 months, and 6 months after surgery. We measured satisfaction using a subsection of the Michigan Hand Outcomes Questionnaire (MHQ) satisfaction score. Measured study variables were linked to their corresponding ICF domain (personal factors, environmental factors, activity and participation, and body function). We then used hierarchical regression to assess the contribution of each ICF domain to variation in overall patient satisfaction at each time point. RESULTS We enrolled 53 patients with unilateral DRFs treated with the volar locking plating system. Regression analysis indicated that measured study variables explain 93% (6 weeks), 98% (3 months), and 97% (6 months) of variation in patient satisfaction. For all 3 study assessment dates, activity and participation variables (MHQ-Activities of Daily Living, MHQ-Work, and Jebsen-Taylor Score) contributed the most to variation in patient satisfaction, whereas personal and environmental factors had a considerably smaller role in predicting changes in patient satisfaction. CONCLUSIONS The results demonstrated that it is possible to reliably model the relative contributions of each ICF domain to patient satisfaction over time, and the findings are consistent with previous research (ie, that most outcome variation is due to physical or functional factors). These results are strong enough to support continued use and further research using the ICF model for upper extremity outcomes.
Collapse
Affiliation(s)
| | - Heidi Reichert
- Center for Statistical Consultation and Research, University of Michigan
| | - H. Myra Kim
- Center for Statistical Consultation and Research, University of Michigan
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System
| |
Collapse
|
92
|
Kennedy SA, Vranceanu AM, Nunez F, Ring D. Association between psychosocial factors and pain in patients with trigger finger. J Hand Microsurg 2010; 2:18-23. [PMID: 23129948 DOI: 10.1007/s12593-010-0009-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To test the hypothesis that psychological factors correlate with pain intensity in trigger finger (TF). METHODS Patients with TF were selected from two previous cohort studies measuring pain intensity and psychological parameters, 82 from one study and 72 from another. Correlation testing and multiple linear regression was performed. Measures included the pain catastrophizing scale (PCS), pain self-efficacy questionnaire (PSEQ), patient health questionnaire depression (PHQ-D) scale, center for epidemiologic studies depression (CES-D) scale, pain anxiety symptoms score (PASS), and the eysenck personality questionnaire (EPQ-R) scales. RESULTS There was moderate correlation between pain intensity and PCS (ρ = 0.52; P < 0.001) and PSEQ (ρ = - 0.36; P < 0.001). There was weak correlation between pain and PHQ-D (ρ = 0.23; P = 0.019). No significant correlation existed with CES-D or EPQ-R. PCS accounted for 26% of the variance in pain for patients awaiting surgery (P < 0.001). CONCLUSION Self-reported pain in TF has moderate correlation with psychological factors, most predominantly pain catastrophizing.
Collapse
Affiliation(s)
- Stephen A Kennedy
- Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, 3114-910 W 10th Avenue, Vancouver, BC V5Z4E3 Canada
| | | | | | | |
Collapse
|
93
|
Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am 2010; 35:956-60. [PMID: 20381981 DOI: 10.1016/j.jhsa.2010.02.001] [Citation(s) in RCA: 172] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 02/02/2010] [Accepted: 02/02/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the null hypothesis that there is no relationship between coping mechanisms and depression measured before surgery, and pain intensity and disability after surgery, as assessed at the time of suture removal. METHODS A total of 120 patients (39 electing surgery for carpal tunnel syndrome, 65 for trigger finger, and 16 for a benign tumor) completed questionnaires measuring depression, pain self-efficacy (confidence that one can perform various activities despite pain), pain anxiety (fear and anxiety in response to pain sensations), and pain catastrophizing (maladaptive cognitive activities such as pain-related rumination, magnification, and helplessness) before surgery. Before the surgery and at the time of suture removal (10 to 14 days after surgery) participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and a numerical pain intensity rating scale. RESULTS At the time of suture removal, there was a significant correlation between pain intensity and depression (r = 0.45, p<.001), pain catastrophizing (r = 0.41, p<.001), pain anxiety (r = 0.32, p<.01), and self-efficacy (r = -0.29, p<.01). Disability correlated with self-efficacy (r = -0.34; p<.001) and depression (r = 0.49; p<.001), but not with pain anxiety and catastrophizing (p>.05). In multivariate analyses, depression was the sole predictor of both disability and pain intensity and accounted for 26% of the variance in DASH scores and 25% of the variance in pain intensity, after removing the influence of preoperative DASH and diagnosis, which accounted for 14% variance. CONCLUSIONS Psychosocial factors, especially depression, explain a notable proportion of the variation in pain intensity and disability after minor hand surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
Collapse
Affiliation(s)
- Ana-Maria Vranceanu
- Department of Behavioral Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | |
Collapse
|
94
|
de Moraes VY, Jorge MR, Faloppa F, Belloti JC. Anxiety and depression in Brazilian orthopaedics inpatients: a cross sectional study with a clinical sample comparison. J Clin Psychol Med Settings 2010; 17:31-7. [PMID: 20111986 DOI: 10.1007/s10880-009-9184-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are few studies on the development of anxiety and depression in orthopaedics and trauma (O&T) inpatients. We designed a cross-sectional study aimed at comparing the prevalence of depression and anxiety in 100 O&T inpatients and 100 clinical inpatients in the same hospital. O&T patients were divided into subgroups: trauma and non-trauma (arthroplasty, tumour, and infection sub grouping). We measured anxiety and depression by the Hospital Anxiety and Depression Scale and co-morbidities by the Charlson age-adjusted comorbidity index (CCI). For the trauma subgroup, AO/OTA fracture classification and Gustillo and Anderson grade of open fractures classification was applied. The prevalence of anxiety and depression was 35% and 28%, respectively for the clinical sample, and 44% and 33% for the O&T sample. Compared with the clinical sample, anxiety scores were higher in the O&T sample (p = .047), and in arthroplasty (p = .020) and trauma subgroups (p = .031). In the O&T sample, high CCI scores were associated with high anxiety scores (p = .033).
Collapse
Affiliation(s)
- Vinícius Ynoe de Moraes
- Department of Orthopaedics and Traumatology, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil.
| | | | | | | |
Collapse
|
95
|
Calderón SAL, Zurakowski D, Davis JS, Ring D. Quantitative Adjustment of the Influence of Depression on the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire. Hand (N Y) 2010; 5:49-55. [PMID: 19495887 PMCID: PMC2820631 DOI: 10.1007/s11552-009-9205-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 05/19/2009] [Indexed: 11/29/2022]
Abstract
Upper extremity specific disability as measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire varies more than expected based upon variations in objective impairment influenced by depression. We tested the hypothesis that adjusting for depression can reduce the mean and variance of DASH scores. Five hundred and sixteen patients (352 men, 164 women) with an average of 58 years of age (range, 18-100) were asked to simultaneously complete the DASH and Center for Epidemiologic Studies Depression Scale (CES-D) scores at their initial visit to a hand surgeon. Pearson's correlations between each of the DASH items and the CES-D score were obtained. The DASH score was then adjusted for the influence of Depression for women and men using ordinary least-squares regression and subtracting the product of the regression coefficient and the CES-D score from the raw DASH score. The average DASH score was 24 points (SD, 19; range, 0-91), and the average CES-D score was 10 points (SD, 8; range, 0-42). Thirteen of the 30 items of the DASH demonstrated correlation greater than r = 0.20. Adjustment of these DASH items for the depression effect led to significant reductions in the mean (5.5 points; p < 0.01) and standard deviation (0.8 points; p < 0.01) of DASH scores. Adjustment for depression alone had a significant but perhaps clinically marginal effect on the variance of DASH scores. Additional research is merited to determine if DASH score adjustments for the most important subjective and psychosocial aspects of illness behavior can improve correlation between DASH scores and objective impairment.
Collapse
Affiliation(s)
| | - David Zurakowski
- Harvard Medical School, Boston, MA USA ,Department of Surgery, Children’s Hospital Boston, Boston Children’s Hospital, Boston, MA USA
| | - James S. Davis
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
| | - David Ring
- Harvard Medical School, Boston, MA USA ,Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| |
Collapse
|
96
|
Cold intolerance in surgically treated neuroma patients: a prospective follow-up study. J Hand Surg Am 2009; 34:1689-95. [PMID: 19766409 DOI: 10.1016/j.jhsa.2009.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 05/26/2009] [Accepted: 06/02/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Cold intolerance may impose great changes on patients' lifestyle, work, and leisure activities, and it is often severely disabling. This study aims to investigate the prevalence and severity of cold intolerance in patients with injury-related neuromas of the upper extremity and improvement of symptoms after surgical treatment. Furthermore, we try to find predictors for cold intolerance and correlations with other symptoms. METHODS Between January 2006 and February 2009, 34 consecutive patients with surgically treated neuroma-specific neuropathic pain of the upper extremities were sent a questionnaire composed of general questions concerning epidemiologic variables and several specific validated questionnaires, including the Visual Analog Scale for pain. To estimate the prevalence of cold intolerance objectively in neuroma patients, we used the validated CISS (Cold Intolerance Symptom Severity) questionnaire with a prespecified cutoff point. RESULTS The CISS questionnaire was filled out by 33 patients before and 30 after surgery for neuroma-specific neuropathic pain, with a mean follow-up time of 24 months. We found a prevalence of cold intolerance of 91% before surgery, with a mean CISS score above the cutoff point for abnormal cold intolerance. After surgery, the prevalence of cold intolerance and the mean CISS score were not significantly different, whereas the mean Visual Analog Scale score decreased significantly (p < .01). CISS scores were lower in patients with neuromas associated with sharp injury of the peripheral nerve (p = .02). A higher VAS score correlated significantly with a higher CISS score (p = .01). CONCLUSIONS Cold intolerance is a difficult and persistent problem that has a high prevalence in patients with a painful injury-related neuroma. There seems to be a relationship between severity of cold intolerance as measured by CISS, pain as measured by the Visual Analog Scale, and type of injury. Cold intolerance may not disappear with time or surgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
|
97
|
Niekel MC, Lindenhovius ALC, Watson JB, Vranceanu AM, Ring D. Correlation of DASH and QuickDASH with measures of psychological distress. J Hand Surg Am 2009; 34:1499-505. [PMID: 19703733 DOI: 10.1016/j.jhsa.2009.05.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Revised: 04/23/2009] [Accepted: 05/20/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE In an attempt to shorten the questionnaires given to patients in both clinical and research settings, we studied whether the correlation of commonly used psychological measures was comparable for the standard Disabilities of the Arm, Shoulder, and Hand (DASH) and the shorter QuickDASH questionnaires. METHODS A cohort of 839 patients with carpal tunnel syndrome, trigger finger, de Quervain's disease, trapeziometacarpal arthrosis, lateral epicondylosis, or a distal radius fracture 2 weeks after surgery, who completed the DASH and 1 or more measures of psychological distress, was created from 10 databases from previously implemented studies. Correlations of the DASH and the QuickDASH with several measures of psychological factors (Center for Epidemiologic Studies Depression Scale [CES-D], Pain Catastrophizing Scale [PCS], and Pain Anxiety Symptoms Scale [PASS-40]) were calculated in both univariate and multivariable analyses. RESULTS There was a large correlation between the DASH and QuickDASH (r = 0.79; p < .001). QuickDASH scores were significantly higher than DASH scores (p < .001). Correlations of the CES-D, PCS, and PASS-40 with the DASH and QuickDASH ranged from small to medium (range, 0.21-0.31; p < .001). There were no significant differences between correlations of the DASH and the QuickDASH with the psychological factors in the cohort including all patients, nor in subgroups according to diagnosis, gender, and limb dominance. CONCLUSIONS The correlations of the DASH and QuickDASH with the CES-D, PCS, and PASS-40 were comparable. Our analysis suggests that a shorter and therefore potentially more practical measure of arm-specific disability can be used in studies that evaluate psychosocial aspects of illness behavior. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
Collapse
Affiliation(s)
- Maarten C Niekel
- Orthotrauma Research Center Amsterdam, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
98
|
Watson J, Shin R, Zurakowski D, Ring D. A survey regarding physician recommendations regarding return to work. J Hand Surg Am 2009; 34:1111-8.e2. [PMID: 19481359 DOI: 10.1016/j.jhsa.2009.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 02/21/2009] [Accepted: 02/25/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Returning patients to work may be influenced by subjective factors and physician bias. The purpose of this study was to determine whether factors such as complaints of pain and patient motivation influence physicians' recommendations regarding return to work or activity. METHODS One hundred twenty-five members of the American Society for Surgery of the Hand completed an online survey describing a 25-year-old patient with surgically treated diaphyseal fractures of the radius and ulna. Physicians were asked whether the patient could be returned to work in 4 distinct scenarios varying with occupation, time since injury, radiographic union, patient motivation, and pain. RESULTS Logistic regression analysis demonstrated that all 5 predictor variables were highly significant predictors of return to work. Pain and diminished motivation were associated with a significantly lower probability of return to work. CONCLUSIONS Although in the scenario depicted, objective factors such as radiographic union and job demands are the major determinants of physician clearance to return to work, physicians are also influenced by patient motivation and complaints of pain.
Collapse
|
99
|
Pfefer MT, Cooper SR, Uhl NL. Chiropractic Management of Tendinopathy: A Literature Synthesis. J Manipulative Physiol Ther 2009; 32:41-52. [PMID: 19121463 DOI: 10.1016/j.jmpt.2008.09.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 08/21/2008] [Accepted: 09/08/2008] [Indexed: 12/17/2022]
Affiliation(s)
- Mark T Pfefer
- Cleveland Chiropractic College, Overland Park, Kansas 66210, USA.
| | | | | |
Collapse
|
100
|
Kadzielski J, Malhotra LR, Zurakowski D, Lee SGP, Jupiter JB, Ring D. Evaluation of preoperative expectations and patient satisfaction after carpal tunnel release. J Hand Surg Am 2008; 33:1783-8. [PMID: 19084178 DOI: 10.1016/j.jhsa.2008.06.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 06/17/2008] [Accepted: 06/19/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE We tested the hypothesis that preoperative expectations affect postoperative satisfaction and arm-specific, self-reported health status after elective carpal tunnel release. METHODS Forty-nine patients having elective carpal tunnel release completed questionnaires evaluating self-rated upper extremity-specific disability using the Disabilities of the Arm Shoulder and Hand (DASH) questionnaire, expectations regarding surgery (Preop Expectations Score), personal importance of upper-extremity function, measures of general optimism, the Life Orientation Test (LOT), as well as health-specific optimism, and the Multidimensional Health Locus of Control scale. Six months after surgery, patients completed a 10-point Likert scale to assess satisfaction, the DASH, and measures determining (1) fulfillment of expectations (Postop Met Expectations Score) and (2) relief of specific systems (Postop Help Score). RESULTS The DASH scores decreased significantly from an average of 37 points before surgery to an average of 15 points 6 months after carpal tunnel release (p<.001), and patients rated their satisfaction (mean +/- standard deviation) as 8 +/- 3. Preoperative expectations did not correlate with patient satisfaction or postoperative DASH scores. Multivariable analyses determined that patient satisfaction was best predicted by fulfillment of expectations (Postop Help Score alone, accounting for 41% of the variance in scores) and postoperative DASH scores were predicted by a combination of Postop Met Expectations Score and the LOT score (accounting for 31% of the variance in scores). CONCLUSIONS As measured in this study, the strongest predictor of satisfaction after carpal tunnel release was relief of symptoms, and the strongest predictors of postoperative disability were met expectations and optimism; however, the majority of the variance in postoperative satisfaction remains unexplained. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
Collapse
Affiliation(s)
- John Kadzielski
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114-2696, USA
| | | | | | | | | | | |
Collapse
|