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Naylor JM, Bhandari P, Descallar J, Yang OO, Rider M, Mayland EC, Tang C, Brady B, Lim D, Santalucia Y, Gabbe BJ, Hassett G, Baker E. Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort. BMC Musculoskelet Disord 2023; 24:805. [PMID: 37821871 PMCID: PMC10568865 DOI: 10.1186/s12891-023-06931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia.
| | - Pratibha Bhandari
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Joseph Descallar
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
| | - Owen Ou Yang
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Mark Rider
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Elizabeth C Mayland
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Bernadette Brady
- Department of Pain Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Yvonne Santalucia
- Multicultural Health Service, South West Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Geraldine Hassett
- Rheumatology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool, BC 1871, NSW, Australia
| | - Elise Baker
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- South Western Sydney Local Health District, Liverpool, Locked Bag 7279, Liverpool BC, 1871, Australia
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Hobby J, Ring D, Larson D. The mind and the hand. J Hand Surg Eur Vol 2023; 48:269-275. [PMID: 36638068 DOI: 10.1177/17531934221143502] [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] [Indexed: 01/14/2023]
Abstract
Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery.
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Affiliation(s)
- Jonathan Hobby
- Department of Trauma and Orthopaedics, North Hampshire Hospital, Basingstoke, UK
| | - David Ring
- University of Texas at Austin Dell Medical School, Austin, TX, USA
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Farzad M, MacDermid J, Rassafiani M. Factor structure of Participation Behavioural Questionnaire (PBQ) in patients with hand injuries. PLoS One 2023; 18:e0267872. [PMID: 36662736 PMCID: PMC9858033 DOI: 10.1371/journal.pone.0267872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Participation is considered a critical outcome of successful rehabilitation and should be evaluated. OBJECTIVE We aimed to evaluate the structural validity of the Participation Behaviour Questionnaire (PBQ) in people with hand injuries. METHODOLOGY The PBQ contains 30 items that measure participation as conceptualized in the ICF. PBQ was developed with Rasch analysis to measure participation in hand injured. A sample of 404 patients with hand injuries and a mean age of 37 (16.0) participated and was randomly split for exploratory and confirmatory factor analysis (EFA/CFA). RESULTS Both EFA and CFA confirmed a four factor-solution. These factors were named: Social Participation and Interpersonal Relationships, Autonomy and Role, Subjective Satisfaction with Participation, Recreational, Sport, and Leisure Time. The value of Cronbach's alpha was 0.96 for the total scale and >0.85 for each subscale. CONCLUSIONS The structural validity of the PBQ was confirmed using both EFA and CFA. The PBQ measures four dimensions of participation.
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Affiliation(s)
- Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, Ontario, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Ontario, Canada
- Department of Occupational therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, Ontario, Canada
- Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - Mehdi Rassafiani
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait
- Paediatric Neurorehabilitation Research Centre, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lucas VJ, Burke S, Selby A, Johnson NA. The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders. J Hand Surg Eur Vol 2023; 48:27-32. [PMID: 36204989 DOI: 10.1177/17531934221128867] [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] [Indexed: 02/03/2023]
Abstract
We investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with psychological disorders thought to be influencing recovery from elective and traumatic hand conditions. Demographic data and psychological assessment scores (Primary Health Questionnaire 9 (PHQ9), General Anxiety Disorder Assessment (GAD7), Impact of Event Scale (IES)) were prospectively collected before and after CBT treatment. One hundred and fourteen patients underwent CBT with 81 completing treatment. Full data was available for 78 (68%) patients. Mean age was 43 (range 13-84) and 63% were women. Sixty-one per cent had sustained a traumatic hand injury. PHQ9, GAD7 and IES scores decreased significantly following treatment. Many patients with hand conditions have associated psychological problems that may influence outcome. CBT in a hand unit setting appears to be an effective treatment. Further research with a control group should investigate whether CBT improves psychological health or if this may occur as patients recover from their physical hand disorder regardless of CBT.Level of evidence: IV.
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Li AT, Shepherd A, Gray SJ, Slattery P, Bruscino-Raiola F. Comparative outcome analysis of osseointegrated reconstruction and replantation for digital amputations. J Hand Surg Eur Vol 2022; 47:453-460. [PMID: 34278813 DOI: 10.1177/17531934211030752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients.Level of evidence: IV.
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Affiliation(s)
- Andrew T Li
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela Shepherd
- Department of Occupational Therapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Steven J Gray
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Philip Slattery
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Frank Bruscino-Raiola
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
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Hogarth E, Bugden B, Liu KPY. Grip strength, functional range and anthropometric dimensions, and indication on fulfilling occupations in the home and workplace: A cross-sectional study. Br J Occup Ther 2022. [DOI: 10.1177/03080226221083228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Little is known about the relationship between the types of grip strength, functional range, anthropometric measures, and function in the home and workplace. The study aimed to determine their relationships and explore their contributions to performing usual work duties and overall function in participants with and without hand and wrist injury. Method Forty-four participants were measured on Maximal Voluntary Isometric Grip Strength, Rapid Exchange Grip Contractions and Isometric Endurance, Forearm Length and Volumetry, and the Dart Thrower’s Motion (DTM) measure. They completed the Patient Rated Wrist and Hand Evaluation and the Disabilities of the Arm, Shoulder and Hand Work Module. Results The grip measures significantly correlated with Volumetry (r = 0.62–0.74) in participants with and without hand and wrist injury. The Isometric Endurance and DTM measure of the non-injured hand were found to be contributing factors for participants with hand and wrist injury when returning to usual work duties and overall function. Conclusion The non-injured hand function plays a role in the overall function for participants with hand and wrist injuries. Isometric Endurance and DTM measure could assist clinicians in determining suitable rehabilitation targets, resulting in a better function required for occupations in the home or workplace.
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Affiliation(s)
- Eliza Hogarth
- Western Sydney University, School of Health Sciences, Penrith NSW, Australia
| | - Benjamin Bugden
- Inner West Hand Therapy & Rehabilitation, Summer Hill, NSW, Australia
| | - Karen PY Liu
- Western Sydney University, School of Health Sciences, Penrith NSW, Australia
- Western Sydney University, Translational Health Research Institute, Penrith NSW, Australia
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Eraslan U, Kitis A, Demirkan AF, Ozcan RH. Effect of electromyographic biofeedback training on functional status in zone I-III flexor tendon injuries: a randomized controlled trial. Physiother Theory Pract 2022:1-11. [PMID: 35229697 DOI: 10.1080/09593985.2022.2043499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite advances in hand therapy and surgery, functional deficits persist after flexor tendon repair especially in zone I-III. This suggests that methods applied may be insufficient. Electromyographic (EMG) biofeedback may provide an effective tendon gliding through visual and auditory feedback. PURPOSE The purpose of this study was to investigate the effect of EMG biofeedback training applied in addition to early passive motion protocol on functional status in zone I-III flexor tendon injuries. METHODS Patients were randomly assigned into two groups, each consisted of 11 patients. In addition to early passive motion method, EMG biofeedback training was applied in the first group. The second group was followed only with early passive motion protocol. Joint range of motion (ROM), Michigan Hand Outcomes Questionnaire (MHQ) and grip strength were evaluated. RESULTS There were no significant differences between the groups in terms of the ROM, MHQ scores and grip strength (p ≥ .087). However, there were clinically important differences in the results of the 12th week ROM (effect size = 0.70), 24th week activity of daily living (ADL) score in MHQ (effect size = 0.68), 12th week gross, tip pinch and lateral grip strength (effect sizes = 0.59, 0.52, 0.81, respectively) and 24th week gross, tip pinch and lateral grip strength (effect sizes = 0.69, 0.73, 0.69, respectively) between the two groups. CONCLUSIONS EMG biofeedback training was clinically but not statistically superior to early passive motion method in terms of the effect on functional status.
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Affiliation(s)
- Umut Eraslan
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ali Kitis
- School of Physical Therapy and Rehabilitation, Pamukkale University, Denizli, Turkey
| | - Ahmet Fahir Demirkan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ramazan Hakan Ozcan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. J Hand Ther 2021; 33:562-570.e1. [PMID: 31481341 DOI: 10.1016/j.jht.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional. INTRODUCTION Pain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain. PURPOSE OF THE STUDY The purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand. METHODS Measures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire. RESULTS The best-fitting regression model with DASH scores entered as the dependent variable (F4,50 = 28.8, P < .01) included MPI Pain Interference (β = -0.54), Life Control (β = -0.16), Purdue pegboard scores (β = -0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R2 = 0.67, P < .01). CONCLUSION Pain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.
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9
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An exploratory study of the impact of firecracker-induced hand injuries on adolescents and their parents. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01861-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Severe hand injuries due to firecrackers are unfortunately common in the Netherlands. These injuries are expected to have long-term functional and psychological sequalae. We performed a study to assess the long-term impact of such injuries on the victims and their parents.
Methods
Eight sequential adolescent patients that underwent surgery for firecracker-induced severe hand injuries between September 2012 and March 2015 were included. The patient files were assessed for data on hand function. The impact of the injuries was measured by questionnaires and measure instruments: VAS for pain, CHEQ2.0 and COPM-DLV for activities and participation, PedsQL-4.0 for participation and quality of life, RSES for self-esteem, and DT-P for impact on parents.
Results
Seven of the eight patients underwent (partial) hand amputation. Three adolescents still reported pain at a mean of 3.2 years post-trauma. All adolescents required more time than peers performing activities. Seven showed a total of 34 activity and participation problems. One adolescent showed no problems at all. The adolescents showed a mean score of 81 on the PedsQL-4.0, which was not different to healthy adolescents. None had problematic low self-esteem. Six out of eight parents had elevated distress; three parents stated that they still needed psychological support.
Conclusions
Severe hand trauma due to firecrackers has an evident impact on hand function and activities in all adolescents. The injuries have a significant long-lasting psychological impact on the parents. Prolonged psychological help is recommended for the adolescents as well as their parents with a more family-centered approach.
Level of evidence: Level IV, therapeutic study.
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Üstün GG, Kargalıoğlu F, Akduman B, Arslan R, Kara M, Gürsoy K, Koçer U. Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment. J Plast Reconstr Aesthet Surg 2021; 75:286-295. [PMID: 34275778 DOI: 10.1016/j.bjps.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/10/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery. PATIENTS/METHODS Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variable on the decision for surgery were analyzed. RESULTS The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery. CONCLUSION Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful conditions. LEVEL OF EVIDENCE Level 4, Case-control study.
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Affiliation(s)
- Galip Gencay Üstün
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey.
| | - Ferhat Kargalıoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Burkay Akduman
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Ramazan Arslan
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Murat Kara
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Koray Gürsoy
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
| | - Uğur Koçer
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey
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Farzad M, MacDermid JC, Mehta S, Grewal R, Shafiee E. Early post-immobilization pain at rest, movement evoked pain, and their ratio as potential predictors of pain and disability at six- and 12-months after distal radius fracture. Arch Physiother 2021; 11:6. [PMID: 33641681 PMCID: PMC7919326 DOI: 10.1186/s40945-021-00101-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
Background Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury. Methods This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability. Results Scores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50). Conclusion Chronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy.
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Affiliation(s)
- Maryam Farzad
- Department of Health and Rehabilitation Sciences, Roth McFarlane Hand and Upper Limb Centre, University of Western Ontario, School of Physical Therapy, St. Joseph's Hospital, London, Ontario, Canada. .,Department of Occupational therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada.,Co-director Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.,Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - Saurabh Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA.,Department of Orthopedic Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Ruby Grewal
- Roth
- McFarlane Hand and Upper Limb Center, Department of Surgery, Western University, London, ON, Canada
| | - Erfan Shafiee
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Means KR, Saunders RJ. Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments. Hand Clin 2021; 37:125-153. [PMID: 33198913 DOI: 10.1016/j.hcl.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There are many outcome measures to choose from when caring for or studying fingertip and nail bed trauma and treatments. This article outlines general outcome measures principles as well as guidelines on choosing, implementing, and interpreting specific tools for these injuries. It also presents recent results from the literature for many of these measures, which can help learners, educators, and researchers by providing a clinical knowledge base and aiding study design.
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Affiliation(s)
- Kenneth R Means
- The Curtis National Hand Center @ MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Rebecca J Saunders
- The Curtis National Hand Center @ MedStar Union Memorial Hospital, Baltimore, MD, USA
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Farzad M, MacDermid JC, Lu Z, Shafiee E. Validation of Persian Version of Patient-Rated Wrist and Hand Evaluation: Confirmatory Factor Analysis and Rasch Analysis. Arch Rehabil Res Clin Transl 2020; 2:100076. [PMID: 33543101 PMCID: PMC7853362 DOI: 10.1016/j.arrct.2020.100076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Objectives To determine the factor structure and test the clinometric properties of wrist and hand version of the Patient-Rated Wrist Evaluation. Design Cross-sectional study using Rasch analysis and factor analysis. Confirmatory factor analysis was conducted to assess the factor structure. Higher-order factor analysis was used to explore the hierarchical structure of the items. The Rasch model was used to assess the overall fit, reliability, validity, and construct unidimensionality. Rasch analysis and factor analysis were conducted using RUMM2030 and LISREL software, respectively. Setting Outpatient hand rehabilitation clinic. Participants A convenience sample of patients (N=206) with various hand injuries who completed the Persian version of the Patient-Rated Wrist and Hand Evaluation (PRWHE-P) at 2 months postinjury. The study included 66 men and 139 women, with a mean age of 40 years. Intervention Not applicable. Main Outcome Measures The PRWHE-P was used as a patient-reported measure of pain and disability in wrist and hand conditions. Results Factor analysis confirmed 3-factor models of the PRWHE-P. Items fit well to the Rasch model in 3 subscales. The PRWHE-P had a good item reliability (0.82) and good internal consistency (0.8). No differential item functioning was detected for age, sex, dominant hand, or injured hand. Conclusions The results of this study indicated that the PRWHE-P with 3 sub scales is a reliable and valid measurement tool and could be used in patients with different wrist and hand disabilities.
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Key Words
- CFA, confirmatory factor analysis
- CFI, comparative fit index
- DIF, differential item functioning
- FA, factor analysis
- Factor analysis
- GFI, goodness of fit index
- ICC, item characteristic curve
- ICF, International Classification of Functioning, Disability and Health
- PRWE, Patient-Rated Wrist Evaluation
- PRWHE, Patient-Rated Wrist and Hand Evaluation
- PRWHE-P, Persian version of the Patient-Rated Wrist and Hand Evaluation
- PSI, person separation index
- RMSEA, root means square error of approximation
- Rehabilitation
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Affiliation(s)
- Maryam Farzad
- School of Physical Therapy, Western University, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada.,Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
| | - Ze Lu
- School of Physical Therapy, Western University, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Erfan Shafiee
- School of Physical Therapy, Western University, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.,Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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14
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Babatunde FO, MacDermid J, Grewal R, Macedo L, Szekeres M. Development and Usability Testing of a Web-Based and Therapist-Assisted Coping Skills Program for Managing Psychosocial Problems in Individuals With Hand and Upper Limb Injuries: Mixed Methods Study. JMIR Hum Factors 2020; 7:e17088. [PMID: 32374265 PMCID: PMC7240444 DOI: 10.2196/17088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 02/21/2020] [Indexed: 01/16/2023] Open
Abstract
Background Ineffective coping has been linked to prolonged pain, distress, anxiety, and depression after a hand and upper limb injury. Evidence shows that interventions based on cognitive behavioral therapy (CBT) may be effective in improving treatment outcomes, but traditional psychological interventions are resource intensive and unrealistic in busy hand therapy practices. Developing web-based, evidence-based psychological interventions specifically for hand therapy may be feasible in clinical practice and at home with reduced training and travel costs. Hand Therapy Online Coping Skills (HOCOS) is a program developed to supplement traditional hand therapy with therapist-assisted coping skills training based on principles from CBT and the Technology Acceptance Model. Objective This study aimed to describe the development and assess the usability of HOCOS to support hand therapists in the management of psychosocial problems. Methods The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) of system design was applied to create HOCOS. The usability testing of HOCOS involved a 2-stage process. In the first step, heuristic testing with information and communications technology (ICT) experts was completed using two sets of heuristics: Monkman heuristics and the Health Literacy Online (HLO) checklist. The second step involved user testing with hand therapists performing a series of online and face-to-face activities, completing 12 tasks on the website using the think-aloud protocol, completing the system usability scale (SUS) questionnaire, and a semistructured feedback interview in 2 iterative cycles. Descriptive statistics and content analyses were used to organize the data. Results In total, 4 ICT experts and 12 therapists completed usability testing. The heuristic evaluation revealed 15 of 35 violations on the HLO checklist and 5 of 11 violations on the Monkman heuristics. Initially, hand therapists found 5 tasks to be difficult but were able to complete all 12 tasks after the second cycle of testing. The cognitive interview findings were organized into 6 themes: task performance, navigation, design esthetics, content, functionality and features, and desire for future use. Usability issues identified were addressed in two iterative cycles. There was good agreement on all items of the SUS. Overall, therapists found that HOCOS was a detailed and helpful learning resource for therapists and patients. Conclusions We describe the development and usability testing of HOCOS; a new web-based psychosocial intervention for individuals with a hand and upper limb injuries. HOCOS targets psychosocial problems linked to prolonged pain and disability by increasing access to therapist-guided coping skills training. We actively involved target users in the development and usability evaluation of the website. The final website was modified to meet the needs and preferences of the participants.
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Affiliation(s)
- Folarin Omoniyi Babatunde
- School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, Hamilton, ON, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, Hamilton, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, Western University, London, ON, Canada.,Department of Physical Therapy, Western University, London, ON, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, Western University, London, ON, Canada.,Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, Institute of Applied Health Science, McMaster University, Hamilton, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, Western University, London, ON, Canada
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15
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Karjalainen T, Jokihaara J. A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects. Hand Clin 2020; 36:107-121. [PMID: 31757343 DOI: 10.1016/j.hcl.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed the current literature to estimate incidence rates for adverse events with pedicled flaps in the hand. We identified 241 different studies reporting adverse events for 6693 flaps. The average incidence rate was 5.4% and total or partial loss of flap constituted 65% of all reported complications. Flaps with reverse or perforator-based flow may be more prone to vascular complications compared with flaps with antegrade flow or skin pedicle. The incidence rates were acceptable in all flaps (1%-10%) and thus the flap can be chosen primarily based on considerations other than risk of adverse events.
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Affiliation(s)
- Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Malvern, Australia; Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 16, Jyväskylä 40620, Finland.
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland; Faculty of Medicine and Health Technology, Tampere University, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland
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16
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Crijns TJ, Bernstein DN, Teunis T, Gonzalez RM, Wilbur D, Ring D, Hammert WC. The Association Between Symptoms of Depression and Office Visits in Patients With Nontraumatic Upper-Extremity Illness. J Hand Surg Am 2020; 45:159.e1-159.e8. [PMID: 31300225 DOI: 10.1016/j.jhsa.2019.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 01/21/2019] [Accepted: 03/08/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Because psychological and social factors increase symptoms and limitations, it is possible that they are also related to higher use of care. METHODS We used a database of an academic outpatient orthopedic department in which patient-reported outcome measures were routinely collected and identified 3,620 patients with de Quervain tendinopathy, ganglion, trapeziometacarpal arthritis, trigger digit, or carpal tunnel syndrome who remained in care at least 3 months. At every office visit, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We conducted multivariable Poisson regression analysis of factors associated with the total number of office visits, accounting for PROMIS scores at the first office visit, age, surgical treatment, sex, diagnosis, and clinician team. RESULTS Operative treatment had the greatest influence on the number of office visits. Other variables associated with the number of visits were female sex, younger age, higher PROMIS Depression scores, and higher Pain Interference scores. CONCLUSIONS Treatment choice had the greatest influence on the number of subsequent visits for atraumatic conditions. The fact that the total number of office visits is associated with greater symptoms of depression and greater pain interference, independent of treatment choice, suggests a relation between mental health and resource use. CLINICAL RELEVANCE Quality improvement efforts and future research might address whether adding strategies to decrease symptoms of depression and optimize coping strategies (to reduce pain interference) might improve upper-extremity health more efficiently than standard treatment alone.
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Affiliation(s)
- Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX
| | - David N Bernstein
- URMC Orthopaedics and Rehabilitation, University of Rochester Medical Center, University of Rochester, Rochester, NY
| | - Teun Teunis
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ron M Gonzalez
- URMC Orthopaedics and Rehabilitation, University of Rochester Medical Center, University of Rochester, Rochester, NY
| | - Danielle Wilbur
- URMC Orthopaedics and Rehabilitation, University of Rochester Medical Center, University of Rochester, Rochester, NY
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX.
| | - Warren C Hammert
- URMC Orthopaedics and Rehabilitation, University of Rochester Medical Center, University of Rochester, Rochester, NY
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17
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Busuioc SA, Karim M, Efanov JI, Demers L, Izadpanah A, Harris P, Arsenault J, Hamasaki T, Bourbonnais D. The Michigan Hand Questionnaire and Brief Michigan Hand Questionnaire were successfully translated to Canadian French. J Hand Ther 2019; 31:564-567. [PMID: 30322749 DOI: 10.1016/j.jht.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 06/08/2018] [Accepted: 08/08/2018] [Indexed: 02/09/2023]
Affiliation(s)
- Sorin Alexandru Busuioc
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Mike Karim
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Johnny Ionut Efanov
- Department of Surgery, Service of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Louise Demers
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Ali Izadpanah
- Department of Surgery, Service of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Patrick Harris
- Department of Surgery, Service of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Josée Arsenault
- Department of Surgery, Service of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Tokiko Hamasaki
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Bourbonnais
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche de l'Institut de réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada.
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18
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MacDermid JC, Valdes K, Szekeres M, Naughton N, Algar L. The assessment of psychological factors on upper extremity disability: A scoping review. J Hand Ther 2019; 31:511-523. [PMID: 29198477 DOI: 10.1016/j.jht.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/17/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury. METHODS Twenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity. RESULTS Twenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs. DISCUSSION The majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient's characteristics and diagnoses. CONCLUSIONS The nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.
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Affiliation(s)
- Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
| | - Kristin Valdes
- Occupational Therapy Department, Gannon University, Ruskin, FL, USA
| | | | | | - Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
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19
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Karjalainen T, Jokinen K, Sebastin SJ, Luokkala T, Kangasniemi OP, Reito A. Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair. J Hand Surg Am 2019; 44:361-365. [PMID: 30115378 DOI: 10.1016/j.jhsa.2018.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 05/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Any loss of range of motion of the finger after flexor tendon repair is an impairment of function, but to what extent it causes disability is not properly understood. The aim of this study was to assess the correlation between perceived function (disability) and objectively measured loss of function (impairment), to understand what impairments are meaningful to patients. METHODS We assessed 49 patients who underwent flexor tendon repair an average of 38 months after repair. We measured the perceived function with the visual analog scale, the 4-step rating scale (poor, fair, good, or excellent), and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. The objective measurement of impairment included active range of motion at each joint, total active motion, grip strength, and 2-point discrimination. We also converted range of motion into 4 categories (poor, fair, good, and excellent) following guidelines from 3 different classification systems (American Society for Surgery of the Hand, Strickland-Glocovac, and revised Strickland). We used Spearman ρ and linear regression to assess the correlation. RESULTS Active range of motion at the distal interphalangeal joint had a strong correlation and total active range of motion of the finger joints had a moderate correlation with perceived function measured using the visual analog scale and DASH score. Other measured impairments did not correlate with perceived function. Objective classification categories also did not correlate with the patient's own assessment. CONCLUSIONS Our results validate the use of range of motion and the DASH questionnaire in assessing flexor tendon repairs. Classification of angular measurement according to the tested systems does not reflect the patient's perspective; it limits the precision of the measurement and adds little value to the measurement itself. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Teemu Karjalainen
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Finland.
| | - Kaisa Jokinen
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Finland
| | - Sandeep J Sebastin
- Department of Hand and Reconstructive Microsurgery, National University Hospital of Singapore, Singapore
| | - Toni Luokkala
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Finland
| | | | - Aleksi Reito
- Unit of Hand Surgery, Department of Surgery, Central Finland Central Hospital, Finland
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Abstract
PURPOSE We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. METHODS A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018. RESULTS We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy. CONCLUSIONS Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
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Jayakumar P, Overbeek CL, Lamb S, Williams M, Funes CJ, Gwilym S, Ring D, Vranceanu AM. What Factors Are Associated With Disability After Upper Extremity Injuries? A Systematic Review. Clin Orthop Relat Res 2018; 476:2190-2215. [PMID: 30188344 PMCID: PMC6259989 DOI: 10.1097/corr.0000000000000427] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/12/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychosocial factors are key determinants of health after upper extremity injuries. However, a systematic review is needed to understand which psychosocial factors are most consistently associated with disability and how the language, conceptualization, and types of measures used to assess disability impact these associations in upper extremity injuries. QUESTIONS/PURPOSES (1) What factors are most consistently associated with disability after upper extremity injuries in adults? (2) What are the trends in types of outcome measures and conceptualization of disability in patients' upper extremity injuries? METHODS We searched multiple electronic databases (PubMED, OVIDSP, PsycInfo, Google Scholar, ISI Web of Science) between January 1, 1996, and December 31, 2016, using terms related to the "upper extremity", "outcome measurement", and "impairment, psychological, social or symptomatic" variables. We included all studies involving adult patients with any musculoskeletal injury and excluded those that did not use patient-reported outcome measures. We identified and screened 9339 studies. Of these, we retained 41 studies that involved conditions ranging from fractures to soft tissue injuries in various regions of the arm. We conducted quality assessment using a 10-item validated checklist and a five-tier strength of evidence assessment. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and registered the review before performing our search (PROSPERO: CRD42017054048). None of the authors received any funding to perform this work. RESULTS Disability after upper extremity injury was most consistently associated with depression (21 cohorts), catastrophic thinking (13 cohorts), anxiety (11 cohorts), pain self-efficacy (eight cohorts), and pain interference (seven cohorts). Social and demographic factors were also associated with disability. Measures of impairment such as ROM and injury severity were least associated with disability. There has been a gradual increase in use of region or condition-specific patient-reported outcome measures and measures of psychological, social, and symptomatic factors over a period since the introduction of the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) around 2000. Approximately 17% of studies (n = 454 of 2628) had instances of unclear, conflicting, or inappropriate terminology and 11% of studies (n = 257 of 2628) involved misrepresentations of outcome measures related to disability. CONCLUSIONS Psychologic and social factors are most consistently associated with disability than factors related to impairment. Further research involving the assessment of depression, anxiety, and coping strategies in cohorts with specific injuries may support decision-making regarding the provision of emotional support and psychologic therapies during recovery. Using the WHO ICF framework to conceptualize disability is key in increasing strength of evidence and allowing accurate comparisons of research in this field. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Prakash Jayakumar
- P. Jayakumar, S. Lamb, S. Gwilym, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Medicine, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK C. L. Overbeek, Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands M. Williams, Department of Sport and Health Sciences, Oxford Brookes University, Oxford, UK C. Funes, Department of Psychiatry (Behavioral Medicine Service), Boston, MA, USA D. Ring, The University of Texas at Austin, Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA A.-M. Vranceanu, Massachusetts General Hospital and Harvard Medical School, Behavioral Medicine Program, Department of Psychiatry, Boston, MA, USA
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Siotos C, Ibrahim Z, Bai J, Payne R, Seal S, Lifchez S, Hyder A. Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention. Public Health 2018; 162:135-146. [DOI: 10.1016/j.puhe.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022]
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Ladds E, Redgrave N, Hotton M, Lamyman M. Systematic review: Predicting adverse psychological outcomes after hand trauma. J Hand Ther 2018; 30:407-419. [PMID: 28237074 DOI: 10.1016/j.jht.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION AND PURPOSE OF THE STUDY After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited. METHODS A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed. RESULTS Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes. DISCUSSION AND CONCLUSION Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Emma Ladds
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - Nathalie Redgrave
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Matthew Hotton
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael Lamyman
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Ring D. More Pain Than Expected After Losing a Finger. J Hand Surg Am 2018; 43:e1. [PMID: 29618420 DOI: 10.1016/j.jhsa.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 02/02/2023]
Affiliation(s)
- David Ring
- Dell Medical School, University of Texas at Austin, Austin, TX
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25
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Oh Y, Drijkoningen T, Menendez ME, Claessen FMAP, Ring D. The Influence of Psychological Factors on the Michigan Hand Questionnaire. Hand (N Y) 2017; 12:197-201. [PMID: 28344534 PMCID: PMC5349404 DOI: 10.1177/1558944716642765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital-based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.
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Affiliation(s)
- Yekyoo Oh
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - David Ring
- Harvard Medical School, Boston, MA, USA,David Ring, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA 02114, USA.
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Vranceanu AM, Beks RB, Guitton TG, Janssen SJ, Ring D. How do Orthopaedic Surgeons Address Psychological Aspects of Illness? THE ARCHIVES OF BONE AND JOINT SURGERY 2017; 5:2-9. [PMID: 28271080 PMCID: PMC5339350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 05/24/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons' attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment. METHODS Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes. RESULTS As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable. CONCLUSION Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.
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Affiliation(s)
- Ana Maria Vranceanu
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Reinier B Beks
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Thierry G Guitton
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Stein J Janssen
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Ring
- Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Abstract
Pain is a unique somatosensory perception that can dramatically affect our ability to function. It is also a necessary perception, without which we would do irreparable damage to ourselves. In this article, the authors assess the impact of pain on function of the hand. Pain can be categorized into acute pain, chronic pain, and neuropathic pain. Hand function and objective measurements of hand function are analyzed as well as the impact of different types of pain on each of these areas.
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Affiliation(s)
- Nicholas Howland
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA
| | - Mariela Lopez
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA
| | - Andrew Y Zhang
- Division of Plastic Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77550, USA.
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Farzad M, Asgari A, Layeghi F, Yazdani F, Hosseini SA, Rassafiani M, Kus S. Exploring the Relation Between Impairment Rating by AMA Guide and Activity and Participation Based on ICF in the Patients with Hand Injuries. J Hand Microsurg 2015; 7:261-7. [PMID: 26578828 PMCID: PMC4642479 DOI: 10.1007/s12593-015-0197-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022] Open
Abstract
The aim of this paper is to analyze the relation between components of disability with distinguished score of impairment, activity and participation questionnaire based on clinical data of persons with hand injuries. Impairment was evaluated by use of AMA guide 6th edition and disability by DASH questionnaire on Convenience sample of patients (N = 117), with chronic hand injuries. Linking and allocating items of the DASH were done based on the ICF Core Set for Hand Conditions and the opinions of a group of experts from different related fields. Data was analyses by using Kappa index, Chi square test and a set of Pearson, Part and Partial correlations coefficient. Most of the DASH items were allocated to the activity; one to four of the items could not be classified and 0 to 22 were classified as having overlap. Participation and activity scores correlated positively with each other (r > 0.80). Impairment had high correlation with activity and participation scores (>73). With controlling the effect of each or both construct, this relation between them with impairment diminished but still significant between activity and impairment. There is a huge overlap in definition of activity and participation. The most effecting item in relation of disability and impairment is activity restriction. Participation had no relation with impairment.
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Affiliation(s)
- Maryam Farzad
- />Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Kodakyar St, Daneshjo Blvd, Evin, Tehran 1985713831 Iran
| | - Ali Asgari
- />Department of Educational Psychology, The University of Kharazmi, Khaghani Ave, Somayeh St., Tehran, Iran
| | - Fereydoun Layeghi
- />Department of Basic Science, The University of Social Welfare and Rehabilitation Sciences, Kodakyar St, Daneshjo Blvd, Evin, Tehran 1985713831 Iran
| | - Farzaneh Yazdani
- />Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straw’s Lane, Marston Oxford, OX3 0FL UK
| | - Seyyed Ali Hosseini
- />Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Kodakyar St, Daneshjo Blvd, Evin, Tehran 1985713831 Iran
| | - Mehdi Rassafiani
- />Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Kodakyar St, Daneshjo Blvd, Evin, Tehran 1985713831 Iran
| | - Sandra Kus
- />Department of Medical Informatics, Biometry and Epidemiology – IBE/Chair for public Health Services Research, Marchioninistr. 17, 81377 Munich, Germany
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