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Plevin D, Herriot P. Perceived injustice: a historical and clinical review of a useful concept for psychiatry. Australas Psychiatry 2024; 32:41-43. [PMID: 37903456 DOI: 10.1177/10398562231211133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Perceived injustice, a concept that arose in pain medicine, refers to an individual's experiences and perceptions of victimisation from injuries resulting in chronic pain. Here, we have undertaken a historical and clinical review on the role of perceived injustice medicine in psychiatry and a systematic review on psychotherapeutic interventions for perceived injustice. METHOD For the systematic review, two studies were identified from a search of six databases. RESULTS Though evidence is limited, psychotherapeutic interventions show promise in addressing perceived injustice and associated symptomatology. CONCLUSION Perceived injustice is a concept which may have great potential utility to psychiatry, particularly in occupational and medicolegal areas. Interventions addressing perceived injustice may help improve clinical outcomes.
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Affiliation(s)
- David Plevin
- Ramsay Clinic Adelaide and Clinical Academic, University of Adelaide, Gilberton, SA, Australia
| | - Peter Herriot
- Pain Management Unit, Flinders Medical Centre, Bedford Park, SA, Australia
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Modise GL, Uys K, Masenge A, du Plooy E. Relationship between demographic characteristics and return-to-work for loss of income claimants at the Motor Vehicle Accident Fund, Botswana. Work 2024; 77:1101-1114. [PMID: 37781840 DOI: 10.3233/wor-220712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The Motor Vehicle Accident (MVA) Fund Botswana compensates claimants who lose their incomes due to road traffic accidents. In Botswana, road traffic accidents are becoming more frequent, and the MVA Fund is experiencing escalating claims. We describe the demographic characteristics of loss of income (LOI) claimants of the MVA Fund Botswana. We assess whether demographic characteristics are related to return to work (RTW). OBJECTIVE We retrospectively reviewed records of MVA Fund claimants and extracted demographic information. We investigated the demographic profile and the relationship between demographic information and RTW. METHODS We reviewed 432 LOI claims received by MVA Fund from January 1, 2015 to December 31, 2020. We descriptively analysed the demographic profiles of claimants. We used a univariate analysis and multivariate logistic regression to determine the association between independent demographic variables and the dependent variable, RTW. RESULTS MVA Fund claimants were on average 37-years-old. Claimants were mostly from low-income socio-economic backgrounds. RTW was significantly associated with injury severity, type of injury, and having a RTW plan offer. The final predictors of RTW, using logistic regression, were time away from work and severity of injury. CONCLUSION In Botswana, claimants who had severe injuries and who stayed away from work for longer were less likely to RTW. The MVA Fund Botswana must recognise the demographic profiles of claimants which are likely to influence RTW.
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Affiliation(s)
- Gofaone Lady Modise
- Department of Occupational Therapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Kitty Uys
- Department of Occupational Therapy, School of Healthcare Sciences, University of Pretoria, Pretoria, South Africa
| | - Andries Masenge
- Department of Statistics, Faculty of Natural and Agriculture Sciences, University of Pretoria, South Africa
| | - Eileen du Plooy
- School of Therapeutic Sciences, Faculty of Health Sciences, eFundanathi, University of the Witwatersrand, Johannesburg, South Africa
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Morris EJ, Gray K, Gibbons PJ, Grayson J, Sullivan J, Amorim AB, Burns J, McKay MJ. Evaluating the Use of PROMs in Paediatric Orthopaedic Registries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1552. [PMID: 37761513 PMCID: PMC10528097 DOI: 10.3390/children10091552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Patient-reported outcome measures (PROMs) provide structured information on the patient's health experience and facilitate shared clinical decision-making. Registries that collect PROMs generate essential information about the clinical course and efficacy of interventions. Whilst PROMs are increasingly being used in adult orthopaedic registries, their use in paediatric orthopaedic registries is not well known. The purpose of this systematic review was to identify the frequency and scope of registries that collect PROMs in paediatric orthopaedic patient groups. In July 2023, six databases were systematically searched to identify studies that collected PROMs using a registry amongst patients aged under 18 years with orthopaedic diagnoses. Of 3190 identified articles, 128 unique registries were identified. Three were exclusively paediatric, 27 were majority paediatric, and the remainder included a minority of paediatric patients. One hundred and twenty-eight registries collected 72 different PROMs, and 58% of these PROMs were not validated for a paediatric population. The largest group of orthopaedic registries collected PROMs on knee ligament injuries (21%). There are few reported dedicated orthopaedic registries collecting PROMs in paediatric populations. The majority of PROMs collected amongst paediatric populations by orthopaedic registries are not validated for patients under the age of 18 years. The use of non-validated PROMs by registries greatly impedes their utility and impact. Dedicated orthopaedic registries collecting paediatric-validated PROMs are needed to increase health knowledge, improve decision-making between patients and healthcare providers, and optimise orthopaedic management.
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Affiliation(s)
- Eleanor J. Morris
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Kelly Gray
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney 2109, Australia;
| | - Paul J. Gibbons
- Sydney Children’s Hospitals Network, The Children’s Hospital at Westmead, Sydney 2145, Australia;
| | - Jane Grayson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Justin Sullivan
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Anita B. Amorim
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
| | - Joshua Burns
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
- Sydney Children’s Hospitals Network, Paediatric Gait Analysis Service of New South Wales, Sydney 2145, Australia
| | - Marnee J. McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia; (E.J.M.); (J.G.); (J.S.); (A.B.A.); (M.J.M.)
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Pavilanis A, Truchon M, Achille M, Coté P, Sullivan MJ. Perceived Injustice as a Determinant of the Severity of Post-traumatic Stress Symptoms Following Occupational Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:134-144. [PMID: 35852696 PMCID: PMC10025196 DOI: 10.1007/s10926-022-10056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The present study assessed the role of perceived injustice in the experience and persistence of post-traumatic stress symptoms (PTSS) following work-related musculoskeletal injury. METHODS The study sample consisted of 187 individuals who were absent from work as a result of a musculoskeletal injury. Participants completed measures of pain severity, perceived injustice, catastrophic thinking, post-traumatic stress symptoms, and disability on three occasions at three-week intervals. RESULTS Consistent with previous research, correlational analyses revealed significant cross-sectional relations between pain and PTSS, and between perceived injustice and PTSS. Regression analysis on baseline data revealed that perceived injustice contributed significant variance to the prediction of PTSS, beyond the variance accounted for by pain severity and catastrophic thinking. Sequential analyses provided support for a bi-directional relation between perceived injustice and PTSS. Cross-lagged regression analyses showed that early changes in perceived injustice predicted later changes in PTSS and early changes in PTSS predicted later changes in perceived injustice. CONCLUSIONS Possible linkages between perceived injustice and PTSS are discussed. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of PTSS consequent to musculoskeletal injury.
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Affiliation(s)
- Antonina Pavilanis
- Department of Psychology, McGill University, 2001 McGill College, H3A 1G1, Montréal, QC, Canada
| | | | | | | | - Michael Jl Sullivan
- Department of Psychology, McGill University, 2001 McGill College, H3A 1G1, Montréal, QC, Canada.
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Butler P, Nguyen T, Giummarra MJ, O'Leary S, Sterling M. Injury perceptions and their association with recovery outcomes in adults with traumatic orthopaedic injuries: a scoping review. Disabil Rehabil 2022; 44:7707-7722. [PMID: 34663157 DOI: 10.1080/09638288.2021.1988732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE How people perceive their injury may be associated with recovery. This scoping review used the Common Sense Model of Illness Perceptions (CSM) as a framework to: (1) characterise injury perceptions; (2) describe biopsychosocial factors related to injury perceptions, and (3) determine how injury perceptions are associated with recovery outcomes. MATERIALS AND METHODS A broad search strategy was used across eight databases to identify studies exploring injury perceptions and related concepts in adults with traumatic orthopaedic injuries. Two reviewers independently screened and extracted data. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS The search yielded 9736 records, of which 22 publications were included; 12 quantitative and 10 qualitative studies. Overall, the quality of the evidence was low to moderate. Consistent with the CSM, injury perceptions comprised beliefs relating to the injury diagnosis, consequences, causes, recovery duration, and treatments. Perceptions of injury were multidimensional and influenced by personal, inter-personal, and socio-cultural factors. Negative injury perceptions were associated with worse functional outcomes. CONCLUSIONS Although this review provided some insight into the characteristics of injury perceptions, relationships between injury perceptions and recovery, and characteristics of perceptions across different socio-cultural or clinical settings are still poorly understood.Implications for rehabilitationA person's perception of their injury is complex; it emerges from dynamic interactions between personal, interpersonal and socio-cultural elements.People who perceive that their injury represents a threat to them typically report higher pain, negative affect, and worse general health than people with more positive perceptions of injury.Rehabilitation providers should consider how they might positively influence perceptions of traumatic orthopaedic injury.Perceptions of injury might be influenced at the individual level (e.g., during healthcare encounters), or at a system level, such as through endorsement of codes of practice for rehabilitation clinicians or funding of psychologically informed treatments to help people better understand their injuries.
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Affiliation(s)
- Prudence Butler
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Thi Nguyen
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Melita J Giummarra
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.,Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Australia
| | - Shaun O'Leary
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, University of Queensland, Brisbane, Australia
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Patterns of patient outcomes following specialist pain management in Australasia: a latent class analysis using the ePPOC database. Pain 2022; 164:967-976. [PMID: 36448970 DOI: 10.1097/j.pain.0000000000002799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022]
Abstract
ABSTRACT The increasing demand for pain management and limited resources available highlight the need to measure treatment effectiveness. We analysed data collected at 75 specialist persistent pain services located in Australia and New Zealand to calculate overall treatment outcome for patients receiving care during 2014-2020. Socio-demographic and clinical information was provided for 23,915 patients, along with patient-reported measures assessing pain, pain interference, depression, anxiety, stress, pain catastrophizing and pain self-efficacy. Latent Class Analysis identified four distinct outcomes based on patients' pattern of responses across the assessment tools at treatment end. Group 1 (n=8,369, 35%) reported low/mild severity across all clinical domains at the end of care, while Group 4 (n= 7,081, 30%) were more likely to report moderate/high severity on all domains. Group 2 (n=1,991, 8%) reported low/mild pain with moderate/high psychological distress at treatment end, and Group 3 (n=6,474, 27%) reported moderate/high pain with low/mild psychological distress. Multi-variable logistic regression identified those factors associated with the different groups. In particular, factors most predictive of a poor (Group 4) vs. good outcome (Group 1) were unemployment (due to pain or other reasons), requiring an interpreter, widespread pain, pain of longer duration and attributing the pain to an injury at work. The results may allow identification of those most likely to benefit from the services currently provided, and inform development of alternative or enhanced services for those at risk of a poor outcome.
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Tan AC, Allen SK, Aziz I, Mercado M, Nanthakumar K, Syed F, Champion GD. Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study. Injury 2022; 53:3201-3208. [PMID: 35843753 DOI: 10.1016/j.injury.2022.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. METHODS This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. RESULTS The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). CONCLUSIONS Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.
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Affiliation(s)
- Aidan Christopher Tan
- School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
| | - Samantha Kate Allen
- Brain Injury Rehabilitation Service, Westmead Hospital, Sydney, NSW, Australia.
| | - Iqra Aziz
- Royal North Shore Hospital, Sydney, NSW, Australia.
| | | | | | - Faisal Syed
- Wollongong Hospital, Sydney, NSW, Australia.
| | - G David Champion
- School of Women's and Children's Health, Department of Pain, University of New South Wales, Sydney, Level 7 Bright Alliance Building, High Street, Randwick, NSW 2031, Australia.
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8
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CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury. Am J Nurs 2022; 122:26-37. [DOI: 10.1097/01.naj.0000873444.48723.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papic C, Kifley A, Craig A, Grant G, Collie A, Pozzato I, Gabbe B, Derrett S, Rebbeck T, Jagnoor J, Cameron ID. Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study. BMC Public Health 2022; 22:1498. [PMID: 35931966 PMCID: PMC9356415 DOI: 10.1186/s12889-022-13884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). Methods Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to ‘any’ or ‘full duties’ paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. Results Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. Conclusions Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW. Trial registration This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).
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Affiliation(s)
- Christopher Papic
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia.
| | - Annette Kifley
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Ashley Craig
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Genevieve Grant
- Australian Centre for Justice Innovation, Faculty of Law, Monash University, Clayton, Victoria, 3800, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Victoria, 3004, Australia
| | - Ilaria Pozzato
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Victoria, 3004, Australia
| | - Sarah Derrett
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Trudy Rebbeck
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, and Faculty of Medicine, University of New South Wales, Level 5/1 King St, Newtown, NSW, 2042, Australia
| | - Ian D Cameron
- Northern Clinical School, Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medican Research, The University of Sydney, Royal North Shore Hospital, Level 12, Corner Reserve Road and Westbourne Street, NSW, 2065, St Leonards, Australia
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Reme SE, Ljosaa TM, Stubhaug A, Granan LP, Falk RS, Jacobsen HB. Perceived Injustice in Patients With Chronic Pain: Prevalence, Relevance, and Associations With Long-Term Recovery and Deterioration. THE JOURNAL OF PAIN 2022; 23:1196-1207. [PMID: 35151872 DOI: 10.1016/j.jpain.2022.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
The Injustice Experience Questionnaire (IEQ) assesses the degree to which chronic pain sufferers perceive injustice in relation to their pain. The aim of the current study was to assess the prevalence and relevance of the IEQ and its association to perceived recovery and deterioration in a naturalistic pain clinic population. Data was obtained from the Oslo University Hospital's Pain Registry. Among 2,950 patients, the prevalence of low (<19), medium (19-29) and high (30+) IEQ was 39%, 32% and 29% respectively. High levels of injustice were positively associated with a wide range of adverse health outcomes. Differences between those with high vs low levels of IEQ were clinically significant for most health outcomes. A Venn diagram analysis showed considerable, but not complete, overlap between IEQ, pain catastrophizing, psychological distress and severe pain intensity. High IEQ was associated with reduced clinical recovery (OR 0.6, 95% CI 0.4-0.9) and deterioration (OR 3.6, 95% CI 2.1-6.2) at 12-months follow-up, however, not when controlling for pain-related disability and pain intensity. We conclude that perceived injustice is a prevalent and clinically relevant phenomenon in a chronic pain clinic population, and that more knowledge is needed regarding its role as indicator of poor prognosis and target for tailored treatment. PERSPECTIVE: This article shows that pain-related injustice is both prevalent and relevant in a large naturalistic pain clinic population. Higher levels of injustice were consistently associated with adverse pain outcomes. Injustice could as such be a viable target for treatment of chronic pain, with potential indirect effects on pain and disability.
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Affiliation(s)
- Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; The Mind-Body Lab, Department of psychology, University of Oslo, Oslo, Norway.
| | - Tone Marte Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Petter Granan
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; The Mind-Body Lab, Department of psychology, University of Oslo, Oslo, Norway
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Bohatko-Naismith J, McCormack L, Weerasekara I, James D, Marley J. Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review. Work 2022; 72:75-90. [DOI: 10.3233/wor-205027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE: The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. METHODS: A scoping review methodology was conducted using the Arksey and O’Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. RESULTS: The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. CONCLUSION: Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.
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Affiliation(s)
- Joanna Bohatko-Naismith
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Lynne McCormack
- School of Psychology, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Ishanka Weerasekara
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Daphne James
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Jeffrey Marley
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
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Lun EWY, Tan AC, Andrews CJ, Champion GD. Electrical injury: Chronic pain, somatosensory dysfunction, post traumatic stress and movement disorders. Injury 2022; 53:1667-1677. [PMID: 35287966 DOI: 10.1016/j.injury.2022.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND AIMS We aimed in this case series to identify shortcomings in assessment of long-term painful and psychosocial consequences of EI and to demonstrate the value of biopsychosocial assessment and the commonalities in outcomes. METHODS We retrospectively analyzed 15 cases from 2004 to 2019 of adult claimants assessed in a medico-legal practice for complex chronic pain disorders secondary to EI. Extensive biopsychosocial information, including 165 data items on pre- and post-injury observations, were collected on each. Cutaneous and deep pressure somatosensory examination was performed and questionnaires for psychological evaluation and restless legs syndrome completed. A comprehensive literature review and descriptive analysis was conducted. RESULTS Pre-injury, most claimants worked (12/15), did not receive government benefits (14/15) and had no primary pain disorder (9/15). EIs were severe (14/15), where chronic post-traumatic pain, typically high impact with nociplastic features, was regional in 5 and widespread in 10. Somatosensory signs in wide distribution in all cases implied central sensitization. Movement disorders included digital dyskinesia (5/15), involuntary muscle contractions (7/15) and restless legs syndrome in 7. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) post-traumatic stress disorder (PTSD) criteria were met in 12/15, and 14/15 experienced depression and impaired sleep. Severe social impacts, notably including loss of employment resulting in financial stresses, were common. CONCLUSIONS Biological, psychological and social consequences of EI revealed extensive similarities. Disability was generally severe, moreso than indicated in clinical records, influenced by relative paucity of primary pathology, inadequate pain-orientated somatosensory testing and insufficient application of biopsychosocial assessment and management.
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Affiliation(s)
- Elizabeth W Y Lun
- University of New South Wales, St Vincent's Clinical School, St Vincent's Hospital, Level 5, deLacy Building, Victoria Street, Darlinghurst, NSW 2010, Australia.
| | - Aidan C Tan
- University of New South Wales, South Western Sydney Clinical School, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia; Western Sydney University, School of Medicine, 30 Narellan Road & Gilchrist Drive, Campbelltown NSW 2560, Australia.
| | - Christopher J Andrews
- Department of Primary Care, University of Queensland, Brisbane, QLD 4072, Australia.
| | - G David Champion
- St Vincent`s Clinic, Rheumatology and Pain Medicine, 438 Victoria St, Darlinghurst, NSW 2010, Australia; University of New South Wales, School of Women's and Children's Health, Level 8, Bright Alliance, High Street, Randwick, NSW 2031, Australia.
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Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S. Perceived Injustice After Mild Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:E157-E164. [PMID: 34145158 PMCID: PMC9345515 DOI: 10.1097/htr.0000000000000698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). DESIGN Observational study. SETTING TBI outpatient unit. PARTICIPANTS Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). MAIN MEASURES The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. RESULTS Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance. CONCLUSIONS Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Nybo
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ljosaa TM, Berg HS, Jacobsen HB, Granan LP, Reme S. Translation and validation of the Norwegian version of the Injustice Experience Questionnaire. Scand J Pain 2022; 22:77-87. [PMID: 34881536 DOI: 10.1515/sjpain-2021-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Perceived injustice is a theoretical construct comprising elements of loss, attribution of blame, and sense of unfairness. Patients with chronic pain often report high levels of perceived injustice, which can have negative impact on physiological and psychosocial aspects and treatment outcome. The Injustice Experience Questionnaire (IEQ) is a self-report 12-item questionnaire that shows good reliability and validity in patients with chronic pain. This study aimed to translate, validate, and expand the use of the Norwegian Injustice Experience Questionnaire (IEQ-N) to a chronic pain population. METHODS A mixed-method approach was used to translate and validate the IEQ-N. It was forward-back translated, linguistically validated, and culturally adapted. Individual cognitive debriefing interviews (n=7) and a focus group interview (n=9) was used to explore the patients' experience with- and understanding of the questionnaire. Statistical descriptive, correlational, factor- and regression analyses were used to investigate the IEQ-N validity, reliability, and factorial structure in a large registry sample (n=3,068) of patients with chronic pain. RESULTS Patients with chronic pain found the IEQ-N relevant. Registry analyses supported that the IEQ-N had a one-factor structure. The internal consistency was high (Chronbach's alpha=0.92). The construct validity was good, with moderate to strong significant univariate correlation (r=0.29-0.71) (p<0.05) between perceived injustice and related constructs of pain catastrophizing, pain severity, disability, psychological distress, and quality of life. Perceived injustice contributed with significant but small unique variance to pain-related factors (i.e., pain intensity, pain-related disability, psychological distress), but the additional contribution beyond pain catastrophizing was small (0.2-6.7%) (p<0.05). CONCLUSIONS Patients in the study found the questionnaire relevant for their situation, and easy to understand. This study provides a reliable and valid Norwegian tool to assess perceived injustice in patients with chronic pain. ETHICAL COMMITTEE NUMBER REK sør-øst, 2016/1942.
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Affiliation(s)
- Tone Marte Ljosaa
- Department of Pain Research and Management & Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Børsting Jacobsen
- Department of Pain Research and Management & Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Lars-Petter Granan
- Department of Pain Research and Management & Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
| | - Silje Reme
- Department of Pain Research and Management & Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway
- The Mind-Body Lab, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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15
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Chen JL, Luo R, Liu M. Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients: A cross-sectional study. World J Clin Cases 2022; 10:919-928. [PMID: 35127906 PMCID: PMC8790454 DOI: 10.12998/wjcc.v10.i3.919] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/22/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research.
AIM To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic, social and clinical risk factors.
METHODS This cross-sectional study was performed in geriatric patients (aged ≥ 60 years, both sexes) with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017. Demographic, social, and clinical characteristics were described. Huaxi Emotional-Distress Index (HEI) was used to evaluate the severity of anxiety and depression status. Differences in continuous variables were tested using the t-test, and differences in categorical variables were assessed using the Pearson χ2 test. Binary logistic regression analyses were used to identify the factors associated with a HEI score > 8.
RESULTS Among the 966 patients, 487 were male and 479 were female, with a mean age of 70.2 ± 7.1 years. The age ranged from 60 to 90 years. Seventy-five patients had an HEI score > 8, accounting for about 7.8% of all patients. A higher Injury Severity Score (4.17 ± 3.10 vs 7.96 ± 6.68, P < 0.001), higher Visual Analog Score (5.05 ± 1.09 vs 6.89 ±1.23, P < 0.001), number of chronic diseases (P < 0.001), injury type (P = 0.038), and education level (P = 0.001) were significantly associated with HEI score > 8. On logistic regression, a higher education level was a protective factor for emotional disorders (P = 0.047), whereas Injury Severity Score (P = 0.024), Visual Analog Score (P < 0.001), two or more chronic diseases (P < 0.001) were the related independent risk factors.
CONCLUSION Emotional disorders are common in geriatric patients with orthopedic trauma. Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.
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Affiliation(s)
- Jia-Lei Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Rong Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ming Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Pozzato I, Kifley A, Craig A, Gopinath B, Tran Y, Jagnoor J, Cameron ID. Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability. Psychol Med 2022; 52:68-79. [PMID: 32515720 DOI: 10.1017/s003329172000166x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification. METHODS A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors). RESULTS Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (-0.11 to -0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = -0.07 (-0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = -1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = -0.14, p = 0.27), but not vice versa. CONCLUSIONS This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.
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Affiliation(s)
- I Pozzato
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A Kifley
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - B Gopinath
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Y Tran
- Centre of Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - J Jagnoor
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Gross DP, Rachor GS, Yamamoto SS, Dick BD, Brown C, Senthilselvan A, Straube S, Els C, Jackson T, Brémault-Phillips S, Voaklander D, Stastny J, Berry T. Characteristics and Prognostic Factors for Return to Work in Public Safety Personnel with Work-Related Posttraumatic Stress Injury Undergoing Rehabilitation. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:768-784. [PMID: 33751310 DOI: 10.1007/s10926-021-09963-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
Public safety personnel (PSP) are at risk of developing posttraumatic stress injury (PTSI) due to exposure to traumatic experiences and accidents. Rehabilitation programs are available, but their success varies. We studied: (1) characteristics of PSP undergoing PTSI rehabilitation in comparison to non-PSP workers; and (2) predictive value of various factors for return to work. Methods A population-based cohort study was conducted using data on injured workers undergoing PTSI rehabilitation. Of the 488 workers included, 131 were PSP. Outcome measures were: (1) return to pre-accident work at rehabilitation discharge; (2) days receiving wage replacement benefits in the year following rehabilitation. Results PSP were mainly employed (90.8%), male (59.5%), paramedics/ambulance workers (58.0%); a minority (43.5%) returned to pre-accident work after rehabilitation. Compared to non-PSP workers, PSP were more likely to initially be diagnosed with psychological injuries (94.7% versus 59.4%, p < 0.001) rather than musculoskeletal injuries. Return to pre-accident work was predicted by shorter injury duration, having a primary mental health diagnosis, working at time of admission, and not having symptoms requiring treatment in a complex rehabilitation program. PSPs were slower to experience full recovery in the year after rehabilitation. Factors predicting fewer benefit days included not having a secondary psychological injury, being employed, and working at time of admission. Conclusions Most PSP did not return to work in full after PTSI rehabilitation. Outcomes are likely to improve by starting treatment earlier and maintaining connections with the workplace.
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Affiliation(s)
- Douglas P Gross
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G 2G4, Canada.
| | - Geoffrey S Rachor
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Bruce D Dick
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Canada
| | - Cary Brown
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | | | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Tanya Jackson
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Jarett Stastny
- Workers' Compensation Board of Alberta, Edmonton, Canada
| | - Theodore Berry
- Workers' Compensation Board of Alberta, Edmonton, Canada
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Shah P, Attia M, Dillon WA, Sulway S, Ranalli P, Rutka JA, Gerretsen P. Receiving Long-Term Disability or Pursuing a Legal Claim May Prevent Recovery From Chronic Dizziness. Laryngoscope 2021; 132:655-661. [PMID: 34591978 DOI: 10.1002/lary.29871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Chronic dizziness (CD) and imbalance have multiple etiologies. CD is strongly linked with psychiatric and psychological comorbidities, thus an interdisciplinary approach, including psychopharmacological interventions, is recommended. Despite the use of this comprehensive treatment approach, the recovery of individuals with CD that pursue long-term disability (LTD) insurance or legal claims (LC) appears hampered. As such, we aimed to compare symptom recovery from CD in an interdisciplinary setting between patients receiving LTD/LC versus those who were not, and to explore the factors that may contribute to changes in symptom severity. STUDY DESIGN Retrospective cohort study. METHODS Dizziness-related diagnoses were extracted from the charts of 195 adults in an outpatient interdisciplinary neurotology clinic in Toronto, Canada. Patients with baseline Dizziness Handicap Inventory (DHI) and Dizziness Catastrophizing Scale (DCS) assessments between August 2012 and July 2018 and a mean follow-up visit within approximately 10 months were included. The study participants were categorized as "LTD/LC+" (n = 92) or "LTD/LC-" (n = 103), referring to either receiving or pursuing LTD/LC or not, respectively. RESULTS There were differences in the mean percentage changes in DHI (t[187] = 3.02, P = .003) and DCS (t[179] = 2.63, P = .009) scores between LTD/LC+ and LTD/LC- patients. LTD/LC+ patients showed 8.0% and 7.6% mean increases in DHI and DCS scores, respectively, whereas LTD/LC- patients showed 21.5% and 25.9% reductions in DHI and DCS scores, respectively, controlling for age, sex, and baseline illness severity. CONCLUSIONS Patients receiving or pursuing LTD insurance or a legal claim did not improve from CD and dizziness catastrophizing compared to those who were not. Future studies are required to test these findings prospectively and to determine the factors that may contribute to symptom recovery, including the anxiety-aggravating effects of the LTD/LC process and the deleterious consequences of developing a sick-role while afflicted with a chronic illness. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mohamed Attia
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Wanda A Dillon
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shaleen Sulway
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Ranalli
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John A Rutka
- Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Campbell Mental Health Research Institute, Centre for Addiction & Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
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A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression. THE JOURNAL OF PAIN 2021; 22:643-654. [DOI: 10.1016/j.jpain.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
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Palumbo AJ, Richmond TS, Webster J, Koilor C, Jacoby SF. The relationship between work and mental health outcomes in Black men after serious injury. Injury 2021; 52:750-756. [PMID: 33627251 PMCID: PMC8084974 DOI: 10.1016/j.injury.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 11/24/2020] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries. METHODS We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization. RESULTS In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR: 2.7, 95% CI: 1.8, 4.2). Additional significant factors included: younger age, lack of or public health insurance and higher lifetime experiences of racism. CONCLUSIONS The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources. POLICY IMPLICATIONS Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.
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Affiliation(s)
- Aimee J Palumbo
- College of Public Health, Temple University, Philadelphia, PA, United States; Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Therese S Richmond
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Jessica Webster
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Christopher Koilor
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sara F Jacoby
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, United States; School of Nursing, University of Pennsylvania, Philadelphia, PA, United States.
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Van Eerd D, Irvin E, Harbin S, Mahood Q, Tiong M. Occupational exposure and post-traumatic stress disorder: A rapid review. Work 2021; 68:721-731. [PMID: 33612516 DOI: 10.3233/wor-203406] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Post-Traumatic Stress Disorder (PTSD) can result from occupational exposures and poses a considerable burden to workers, their families, workplaces and to society in general. OBJECTIVE Our objective was to conduct a rapid review of the literature to answer the question: "Which occupations have exposures that may lead to a PTSD diagnosis?" METHODS A rapid review was conducted in six steps: review question development, literature search, study selection (inclusion/exclusion), study characterization, data extraction, and data synthesis. RESULTS The search identified 3428 unique references which were reviewed to find 16 relevant studies in 23 articles. The articles revealed associations between PTSD and rescue workers (police, firefighters, etc.), health care professionals, transit drivers, and bank employees which seem well supported by the literature. Some studies also suggest potential associations with PTSD and construction and extraction, electricians, manufacturing, installation, maintenance and repair, transportation and material moving, and clerical workers. CONCLUSIONS A rapid review of the peer-reviewed scientific literature of PTSD prevalence or treatment suggests many occupations have exposures that could be associated with PTSD. Occupational traumatic events were most often associated with PTSD diagnosis. More research is needed to better understand the association between occupation and PTSD.
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Affiliation(s)
- D Van Eerd
- Institute for Work & Health, Toronto, ON, Canada
| | - E Irvin
- Institute for Work & Health, Toronto, ON, Canada
| | - S Harbin
- Institute for Work & Health, Toronto, ON, Canada
| | - Q Mahood
- Institute for Work & Health, Toronto, ON, Canada
| | - M Tiong
- Institute for Work & Health, Toronto, ON, Canada
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Abstract
BACKGROUND Millions of Americans are injured each year, with 75% suffering orthopedic injuries. Those with orthopedic injury often experience postinjury symptoms, such as anxiety, that negatively influence long-term outcomes. The purpose of this systematic review was to evaluate (1) the prevalence of anxiety symptoms chronologically in relation to time of orthopedic injury, (2) the associations of anxiety symptoms with other symptoms in individuals with orthopedic injury, and (3) the associations between anxiety symptoms and functional performance and mental health outcomes in individuals with orthopedic injury. METHODS The databases CINAHL, Ovid MEDLINE, Ovid PsycInfo, Ovid Embase, ProQuest, and ClinicalTrials.gov were searched on June 25, 2020. Studies were selected for review if (1) participants were 16 years or older, (2) the prevalence of anxiety symptoms was listed, (3) anxiety symptoms were assessed using a validated instrument, (4) the study was published in English, and (5) more than 50% of the participants suffered orthopedic injury to the appendicular skeleton or pelvic ring. RESULTS Anxiety symptoms were present in 11.5%-55.9% of individuals up to 10 years after orthopedic injury and often co-occurred with those of depression, pain, and posttraumatic stress disorder to negatively influence functional performance and mental health outcomes. CONCLUSIONS Anxiety symptoms post-orthopedic injury are highly prevalent and persistent. Anxiety symptoms are associated with other distressing symptoms and influence long-term outcomes. These findings highlight the need to screen for and treat anxiety symptoms following orthopedic injury and may help in designing future self-management interventions.
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Affiliation(s)
- Stephen Breazeale
- Yale University, New Haven, Connecticut (Mr Breazeale and Drs Conley and Redeker); and Yale New Haven Hospital, New Haven, Connecticut (Mr Gaiser)
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Breazeale S, Dorsey SG, Kearney J, Conley S, Jeon S, Yoo B, Redeker NS. Symptom cluster profiles following traumatic orthopedic injuries: A protocol. Res Nurs Health 2020; 44:268-278. [PMID: 33368378 DOI: 10.1002/nur.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/27/2020] [Accepted: 12/13/2020] [Indexed: 11/09/2022]
Abstract
Traumatic injuries affect millions of Americans annually, resulting in $671 billion in healthcare costs and lost productivity. Postinjury symptoms, like pain, sleep disturbance, anxiety, depression, and stressor-related disorders are highly prevalent following traumatic orthopedic injuries (TOI) and may contribute to negative long-term outcomes. Symptoms rarely present in isolation, but in clusters of two or more symptoms that co-occur to affect health in aggregate. Identifying symptom cluster profiles following TOI may identify those at highest risk for negative outcomes. Dysregulation of brain-derived neurotrophic factor (BDNF) is a potential biological mechanism responsible for symptom cluster profile membership after TOI and may be targeted in future precision-health applications. The purpose of this paper is to present the protocol of a cross-sectional study designed to identify symptom cluster profiles and measure the extent to which the BDNF val66met mutation and serum concentration of BDNF are associated with membership in symptom cluster profiles. We plan to recruit 150 TOI survivors within the first 72 h of injury. The study aims are to (1) describe TOI survivors' membership in symptom cluster profiles, indicated by pain, sleep disturbance, and symptoms of anxiety, depression, and stressor-related disorders, immediately following a TOI; (2) examine associations between demographic and clinical factors and symptom cluster profile membership among TOI survivors; (3) test the hypothesis that low serum concentrations of BDNF are associated with membership among symptom cluster profiles following TOI; and (4) test the hypothesis that the presence of the val66met mutation on one or both alleles of the BDNF gene is associated with membership among symptom cluster profiles following TOI.
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Affiliation(s)
| | - Susan G Dorsey
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Joan Kearney
- Yale School of Nursing, West Haven, Connecticut, USA
| | | | | | - Brad Yoo
- Yale School of Medicine, New Haven, Connecticut, USA
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Lau G, Gabbe BJ, Collie A, Ponsford J, Ameratunga S, Cameron PA, Harrison JE, Giummarra MJ. The Association Between Fault Attribution and Work Participation After Road Traffic Injury: A Registry-Based Observational Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:235-254. [PMID: 31820220 DOI: 10.1007/s10926-019-09867-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To characterise associations between fault attribution and work participation and capacity after road traffic injury. Methods People aged 15-65 years, working pre-injury, without serious brain injury, who survived to 12 months after road traffic injury were included from two Victorian trauma registries (n = 2942). Fault profiles from linked compensation claims were defined as no other at fault, another at fault, denied another at fault, claimed another at fault, and unknown. Claimant reports in the denied and claimed another at fault groups contradicted police reports. Patients reported work capacity (Glasgow outcome scale-extended) and return to work (RTW) at 6, 12 and 24 months post-injury (early and sustained RTW, delayed RTW (≥ 12 months), failed RTW attempts, no RTW attempts). Analyses adjusted for demographic, clinical and injury covariates. Results The risk of not returning to work was higher if another was at fault [adjusted relative risk ratio (aRRR) = 1.67, 95% confidence interval (CI) 1.29, 2.17] or was claimed to be at fault (aRRR = 1.58, 95% CI 1.04, 2.41), and lower for those who denied that another was at fault (aRRR = 0.51, 95% CI 0.29, 0.91), compared to cases with no other at fault. Similarly, people had higher odds of work capacity limitations if another was at fault (12m: AOR = 1.49, 95% CI 1.24, 1.80; 24m: 1.63, 95% CI 1.35, 1.97) or was claimed to be at fault (12m: AOR = 1.54, 95% CI 1.16, 2.05; 24m: AOR = 1.80, 95% CI 1.34, 2.41), and lower odds if they denied another was at fault (6m: AOR = 0.67, 95% CI 0.48, 0.95), compared to cases with no other at fault. Conclusion Targeted interventions are needed to support work participation in people at risk of poor RTW post-injury. While interventions targeting fault and justice-related attributions are currently lacking, these may be beneficial for people who believe that another caused their injury.
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Affiliation(s)
- Georgina Lau
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, SA2 8PP, UK
| | - Alex Collie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, SA, Australia
| | - Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, VIC, Australia.
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Carriere JS, Donayre Pimentel S, Yakobov E, Edwards RR. A Systematic Review of the Association Between Perceived Injustice and Pain-Related Outcomes in Individuals with Musculoskeletal Pain. PAIN MEDICINE 2020; 21:1449-1463. [DOI: 10.1093/pm/pnaa088] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjectiveA growing body of literature shows that justice-related appraisals are significant determinants of pain-related outcomes and prolonged trajectories of recovery. We conducted a systematic review of the literature assessing the relationship between perceived injustice and pain-related outcomes in individuals with musculoskeletal pain.Design and ParticipantsA search of published studies in English in PubMed, PsychInfo, Embase, and Cochrane Database of Systematic Reviews from database inception through May 2019 was performed. Search terms included “perceived injustice,” “injustice appraisals,” “perceptions of injustice,” and “pain” or “injury.”ResultsThirty-one studies met inclusion criteria. Data for a total of 5,969 patients with musculoskeletal pain were extracted. Twenty-three studies (71.9%) reported on individuals with persistent pain lasting over three months, and 17 studies (53.1%) reported on individuals with injury-related musculoskeletal pain. Significant associations were found between perceived injustice and pain intensity, disability and physical function, symptoms of depression and anxiety, post-traumatic stress disorder, quality of life and well-being, and quality of life and social functioning.ConclusionsThis systematic review summarizes the current evidence for the association between perceived injustice and pain-related outcomes. There is strong evidence that perceived injustice is associated with pain intensity, disability-related variables, and mental health outcomes. Implications and directions for future research are discussed.
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Affiliation(s)
- Junie S Carriere
- Department of Anesthesiology, Brigham and Women’s Hospital Pain Management Center, Harvard Medical School, Massachusetts, USA
| | | | - Esther Yakobov
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women’s Hospital Pain Management Center, Harvard Medical School, Massachusetts, USA
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Zdziarski-Horodyski L, Vasilopoulos T, Horodyski M, Hagen JE, Sadasivan KS, Sharififar S, Patrick M, Guenther R, Vincent HK. Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial. Clin Orthop Relat Res 2020; 478:792-804. [PMID: 32032087 PMCID: PMC7282578 DOI: 10.1097/corr.0000000000001140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 01/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability []. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors []. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience. QUESTIONS/PURPOSES We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care. METHODS Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury []; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years ± 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively (handgrip strength, active joint ROM, and Lower Extremity Gain Scale) and subjectively (Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS®-PF] and Tampa Scale of Kinesiophobia). Higher values for hand grip, Lower Extremity Gain Scale (score range 0-27), and PROMIS®-PF (population norm = 50) are indicative of higher functional ability. Lower Tampa Scale of Kinesiophobia (score range 11-44) scores indicate less fear of movement. Trajectories of these measures were determined across time points. RESULTS We found no differences at 6 months follow-up between usual care and integrative care in terms of handgrip strength (right handgrip strength β = -0.0792 [95% confidence interval -0.292 to 0.133]; p = 0.46; left handgrip strength β = -0.133 [95% CI -0.384 to 0.119]; p = 0.30), or Lower Extremity Gain Scale score (β = -0.0303 [95% CI -0.191 to 0.131]; p = 0.71). The only differences between usual care and integrative care in active ROM achieved by final follow-up within the involved extremity was noted in elbow flexion, with usual care group 20° ± 10° less than integrative care (t [27] = -2.06; p = 0.05). Patients treated with usual care and integrative care showed the same Tampa Scale of Kinesiophobia score trajectories (β = 0.0155 [95% CI -0.123 to 0.154]; p = 0.83). CONCLUSION Our early psychosocial intervention did not change the trajectory of physical function recovery compared with usual care. Although this specific intervention did not alter recovery trajectories, these interventions should not be abandoned because the greatest gains in function occur early in recovery after trauma, which is the key time in transition to home. More work is needed to identify ways to capitalize on improvements earlier within the recovery process to facilitate functional gains and combat psychosocial barriers to recovery. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Laura Zdziarski-Horodyski
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
- L. Zdziarski-Horodyski, Department of Orthopaedics and Sports Medicine, University of Utah, Salt Lake City, UT, USA
| | - Terrie Vasilopoulos
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
- T. Vasilopoulos, Department of Anesthesia, University of Florida, Gainesville, FL, USA
| | - MaryBeth Horodyski
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Jennifer E Hagen
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kalia S Sadasivan
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Sharareh Sharififar
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Matthew Patrick
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Robert Guenther
- R. Guenther, Department of Clinical Psychology, University of Florida, Gainesville, FL, USA
| | - Heather K Vincent
- L. Zdziarski-Horodyski, T. Vasilopoulos, MB. Horodyski, J. E. Hagen, K. H. Sadasivan, S. Sharififar, M. Patrick, H. K. Vincent, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Tracy LM, Edgar DW, Schrale R, Cleland H, Gabbe BJ. Predictors of itch and pain in the 12 months following burn injury: results from the Burns Registry of Australia and New Zealand (BRANZ) Long-Term Outcomes Project. BURNS & TRAUMA 2020; 8:tkz004. [PMID: 32346541 PMCID: PMC7175773 DOI: 10.1093/burnst/tkz004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 12/02/2019] [Indexed: 11/14/2022]
Abstract
Background Itch and pain are common complaints of patients with burn injuries. This study aimed to describe the prevalence and predictors of itch and moderate to severe pain in the first 12 months following a burn injury, and determine the association between itch, moderate to severe pain, work-related outcomes, and health-related quality of life following a burn injury. Methods Burn patients aged 18 years and older were recruited from five Australian specialist burn units. Patients completed the 36-item Short Form Health Survey Version 2 (SF-36 V2), the Sickness Impact Profile (SIP) work scale, and a specially developed questionnaire relating to itch at 1, 6, and 12 months post-injury. Moderate to severe pain was defined as a score less than 40 on the bodily pain domain of the SF-36 V2. Multivariate mixed-effects regression models were used to identify patient and burn injury predictors of itch and moderate to severe pain. Results Three hundred and twenty-eight patients were included. The prevalence of itch decreased from 50% at 1 month to 27% at 12 months. Similarly, the prevalence of moderate to severe pain decreased from 23% at 1 month to 13% at 12 months. Compared to patients aged 18-34, the adjusted odds of experiencing any itch were 59% (95% CI: 0.20, 0.82) and 55% (95% CI: 0.22, 0.91) lower for patients aged between 35 and 49 and ≥ 50 years, respectively. Compared to patients aged 18-34, the adjusted odds of experiencing moderate to severe pain were 3.12 (95% CI: 1.35, 7.20) and 3.42 (95% CI: 1.47, 7.93) times higher for patients aged 35-49 and ≥ 50 years, respectively. Conclusions Less than 15% of patients reported moderate or severe pain at 12 months, while approximately one-quarter of the patients reported itch at the same period. The presence of moderate to severe pain was associated with a greater negative impact on health-related quality of life and work outcomes compared to itch. Further research is needed to improve our ability to identify patients at higher risk of persistent itch and pain who would benefit from targeted review and intervention studies.
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Affiliation(s)
- Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, Western Australia, 6150, Australia.,Burn Injury Research Node, The University of Notre Dame, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia
| | - Rebecca Schrale
- Tasmanian Burns Unit, Burns & Surgical Specialties Unit 5A, Royal Hobart Hospital, GPO Box 1061, Hobart, Tasmania, 7001, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, The Alfred, Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales SA28PP, United Kingdom
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Schindl M, Wassipaul S, Wagner T, Gstaltner K, Bethge M. Impact of Functional Capacity Evaluation on Patient-Reported Functional Ability: An Exploratory Diagnostic Before-After Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:711-717. [PMID: 30796579 DOI: 10.1007/s10926-019-09829-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction Work capacity in patients with orthopedic trauma and long-lasting inactivity is significantly reduced. Functional capacity evaluation (FCE) is a diagnostic approach for developing recommendations for a return to work and further occupational rehabilitation when the ability to carry out previous job demands is uncertain. However, FCE may also have direct effects on the patients' appraisal of their functional ability. Our study therefore evaluated the change in patient-reported functional ability after the performance of an FCE. Methods We performed a diagnostic before-after study in 161 consecutively recruited patients with trauma who were referred for FCE at the end of an interdisciplinary inpatient rehabilitation program in Austria. Patients completed the Spinal Function Sort to assess patient-reported functional ability both prior to the FCE and after completing it. Results Patient-reported functional ability (0-200 points) improved by 14.8 points (95% CI 11.3-18.2). The number of participants who rated their functional ability below their functional capacity as observed by the FCE decreased from 82.6 to 64.6% by about 18 percentage points. Conclusions The performance of the FCE in patients with trauma was associated with an improvement of patient-reported functional ability. The performance of an FCE in trauma rehabilitation may possibly have a direct therapeutic effect on the patient by allowing a more realistic appraisal of the ability to perform relevant work activities.
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Affiliation(s)
- Martin Schindl
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria.
| | - Sylvia Wassipaul
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria
| | - Tanja Wagner
- Abteilung Statistik, Hauptstelle AUVA, A. Stifter-Straße 65, 1200, Wien, Austria
| | - Karin Gstaltner
- Rehabilitationszentrum Weißer Hof, AUVA, Holzgasse 350, 3400, Klosterneuburg, Austria
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Abstract
The acute phase of complex regional pain syndrome (CRPS) is pathophysiologically characterized by an activation of the immune system and its associated inflammatory response. During the course of CRPS, central nervous symptoms like mechanical hyperalgesia, loss of sensation, and body perception disorders develop. Psychological factors such as pain-related anxiety and traumatic events might have a negative effect on the treatment outcome. While the visible inflammatory symptoms improve, the pain often persists. A stage adapted, targeted treatment could improve the prognosis. Effective multidisciplinary treatment includes the following: pharmacotherapy with steroids, bisphosphonates, or dimethylsulfoxide cream (acute phase), and antineuropathic analgesics (all phases); physiotherapy and behavioral therapy for pain-related anxiety and avoidance of movement; and interventional treatment like spinal cord or dorsal root ganglion stimulation if noninvasive options failed.
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Affiliation(s)
- V Dimova
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland.
| | - F Birklein
- Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland
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Rahbari A, Dehestani M, Baharlouei H. Psychometric Characteristics of the Persian Version of the Injustice Experience Questionnaire. PSYCHOLOGICAL INJURY & LAW 2019. [DOI: 10.1007/s12207-019-09344-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Examining Injustice Appraisals in a Racially Diverse Sample of Individuals With Chronic Low Back Pain. THE JOURNAL OF PAIN 2018; 20:83-96. [PMID: 30179671 DOI: 10.1016/j.jpain.2018.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022]
Abstract
Injustice perception has emerged as a risk factor for problematic musculoskeletal pain outcomes. Despite the prevalence and impact of chronic low back pain (CLBP), no study has addressed injustice appraisals specifically among individuals with CLBP. In addition, despite racial/ethnic disparities in pain, existing injustice research has relied almost exclusively on white/Caucasian participant samples. The current study examined the associations between perceived injustice and pain, disability, and depression in a diverse community sample of individuals with CLBP (N = 137) -51 (37.2%) white, 43 (31.4%) Hispanic, 43 (31.4%) black or African American). Anger variables were tested as potential mediators of these relationships. Controlling for demographic and pain-related covariates, perceived injustice accounted for unique variance in self-reported depression and disability outcomes, but not pain intensity. State and trait anger, and anger inhibition mediated the association between perceived injustice and depression; no additional mediation by anger was observed. Significant racial differences were also noted. Compared with white and Hispanic participants, black participants reported higher levels of perceived injustice related to CLBP, as well as higher depression and pain-related disability. Black participants also reported higher pain intensity than white participants. Current findings provide initial evidence regarding the role of injustice perception specifically in the context of CLBP and within a racially diverse participant sample. Results highlight the need for greater diversity within injustice and CLBP research as well as research regarding socially informed antecedents of injustice appraisals. Perspective: Perceived injustice predicted worse outcomes in CLBP, with effects partially mediated by anger. Black participants reported worse pain outcomes and higher injustice perception than their white or Hispanic counterparts. Given racial inequities within broader health and pain-specific outcomes, this topic is critical for CLBP and perceived injustice research.
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Hodgson CL, Haines KJ, Bailey M, Barrett J, Bellomo R, Bucknall T, Gabbe BJ, Higgins AM, Iwashyna TJ, Hunt-Smith J, Murray LJ, Myles PS, Ponsford J, Pilcher D, Udy AA, Walker C, Young M, Jamie Cooper DJ. Predictors of return to work in survivors of critical illness. J Crit Care 2018; 48:21-25. [PMID: 30138904 DOI: 10.1016/j.jcrc.2018.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine predictors of inability to return to work due to health six-months after intensive care admission; and compare functional recovery between patients who had not returned to work and employed patients. METHODS Participants were working adults admitted to ICU who received >24 h of mechanical ventilation. Outcomes included inability to return to work due to health at six-months post-ICU admission, disability, health status, anxiety, depression and post-traumatic stress. RESULTS Of 107 patients, 31 (29%) were unable to return to work due to health at six-months after ICU admission. Predictors of inability to return to work included longer hospital stay (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.02-1.08; P = .004); lower Glasgow Coma Scale (GCS) at admission (OR, 0.86; CI, 0.75-0.99; P = .03); and admission due to major trauma (OR, 8.83; CI, 2.57-30.38; P < .001). Compared to employed patients, those who had not returned to work reported higher levels of disability and psychological distress, and poorer health-related quality of life. CONCLUSION Major trauma, lower GCS and increased hospital length of stay predicted inability to return to work due to health at six-months post-ICU admission. Compared to employed patients, those who had not returned to work reported poorer functional recovery.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia.
| | - Kimberley J Haines
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Western Health, PO Box 294, St Albans, VIC 3021, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Jonathan Barrett
- Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia; Epworth Health, 89 Bridge Road, Richmond, VIC 3121, Australia
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Austin Health, PO Box 5555, Heidelberg, VIC 3084, Australia
| | - Tracey Bucknall
- The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Farr Institute, Swansea University Medical School, Swansea University, UK
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Theodore J Iwashyna
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; University of Michigan, MI, USA
| | | | - Lynne J Murray
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
| | - Paul S Myles
- The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
| | - Jennie Ponsford
- Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - Craig Walker
- Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Meredith Young
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia
| | - D J Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia; The Alfred Hospital, PO Box 315, Prahran, VIC 3181, Australia; Monash Partners Advanced Health Research and Translation Centre, Locked Bag 29, Clayton, VIC 3168, Australia
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Iverson GL, Terry DP, Karr JE, Panenka WJ, Silverberg ND. Perceived Injustice and Its Correlates after Mild Traumatic Brain Injury. J Neurotrauma 2018; 35:1156-1166. [DOI: 10.1089/neu.2017.5402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
| | - Douglas P. Terry
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts
| | - Justin E. Karr
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - William J. Panenka
- British Columbia Neuropsychiatry Program, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada
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Yun JA, Huh HJ, Han HS, Huh S, Chae JH. Bereaved families are still embittered after the Sewol ferry accident in Korea: A follow-up study 18 and 30months after the disaster. Compr Psychiatry 2018; 82:61-67. [PMID: 29407360 DOI: 10.1016/j.comppsych.2017.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/15/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The Sewol ferry accident that occurred in April 2014 was one of the most tragic human-made disasters in Korean history. Due to the deaths of hundreds of children, bereaved families likely feel embittered; however, there is little extant research documenting embitterment among those who experienced the disaster. Consequently, we investigated bereaved family members' embitterment and other psychiatric symptoms 18months and 30months after the disaster. METHODS Data from a cross-sectional survey were obtained 18months (Time 1) and 30months (Time 2) after the disaster. We ascertained socio-demographic variables and variables obtained from a self-reporting questionnaire (i.e., depression, anxiety, posttraumatic stress disorder, complicated grief, and embitterment) among 56 bereaved family members. RESULTS Bereaved families showed substantial embitterment at Time 1 (64.3%), which increased at Time 2 (76.8%, t=1.761, p=0.084). The participants who displayed increased embitterment at Time 2 also increased in anxiety, post-traumatic stress symptoms, and complicated grief (but not depression). Furthermore, participants who displayed decreased embitterment at Time 2 also decreased in all other psychiatric symptoms. (time×group interaction in depression (F 0.644, p=0.426), anxiety (F 4.970, p=0.030), PTSD (F 10.699, p=0.002), and complicated grief (F 8.389, p=0.005)). CONCLUSIONS Embitterment of bereaved families had not ceased after 18months and even increased 1year later. Additionally, as embitterment increased, many other psychiatric symptoms also increased, and vice versa. Our results suggest that embitterment is associated or can even influence other psychiatric symptoms; therefore, embitterment should be examined after disasters.
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Affiliation(s)
- Ji-Ae Yun
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Hyu-Jung Huh
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Hye-Sung Han
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Seung Huh
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, 222 Banpodaero, Seocho-Gu, Seoul 137-701, Republic of Korea.
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Injustice perceptions about pain: parent–child discordance is associated with worse functional outcomes. Pain 2018; 159:1083-1089. [DOI: 10.1097/j.pain.0000000000001192] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Birklein F, Dimova V. Complex regional pain syndrome-up-to-date. Pain Rep 2017; 2:e624. [PMID: 29392238 PMCID: PMC5741324 DOI: 10.1097/pr9.0000000000000624] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/11/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023] Open
Abstract
Complex regional pain syndrome (CRPS) was described for the first time in the 19th century by Silas Weir Mitchell. After the exclusion of other causes, CRPS is characterised by a typical clinical constellation of pain, sensory, autonomic, motor, or trophic symptoms which can no longer be explained by the initial trauma. These symptoms spread distally and are not limited to innervation territories. If CRPS is not improved in the acute phase and becomes chronic, the visible symptoms change throughout because of the changing pathophysiology; the pain, however, remains. The diagnosis is primarily clinical, although in complex cases further technical examination mainly for exclusion of alternative diagnoses is warranted. In the initial phase, the pathophysiology is dominated by a posttraumatic inflammatory reaction by the activation of the innate and adaptive immune system. In particular, without adequate treatment, central nociceptive sensitization, reorganisation, and implicit learning processes develop, whereas the inflammation moderates. The main symptoms then include movement disorders, alternating skin temperature, sensory loss, hyperalgesia, and body perception disturbances. Psychological factors such as posttraumatic stress or pain-related fear may impact the course and the treatability of CRPS. The treatment should be ideally adjusted to the pathophysiology. Pharmacological treatment maybe particularly effective in acute stages and includes steroids, bisphosphonates, and dimethylsulfoxide cream. Common anti-neuropathic pain drugs can be recommended empirically. Intravenous long-term ketamine administration has shown efficacy in randomised controlled trials, but its repeated application is demanding and has side effects. Important components of the treatment include physio- and occupational therapy including behavioural therapy (eg, graded exposure in vivo and graded motor imaging). If psychosocial comorbidities exist, patients should be appropriately treated and supported. Invasive methods should only be used in specialised centres and in carefully evaluated cases. Considering these fundamentals, CRPS often remains a chronic pain disorder but the devastating cases should become rare.
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Affiliation(s)
- Frank Birklein
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Violeta Dimova
- Department of Neurology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
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