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Bindi VE, Hones KM, Schoch BS, Hampton HL, Wright TW, King JJ, Hao KA. The influence of depression on clinical outcomes of total shoulder arthroplasty: a systematic Review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1757-1763. [PMID: 38526619 DOI: 10.1007/s00590-024-03911-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Much of the current literature on total shoulder arthroplasty (TSA) has assessed the impact of preoperative medical comorbidities on postoperative clinical outcomes. The literature concerning the impact of psychological disorders such as depression on TSA has increased in popularity in recent years, but there lacks a thorough review of the influence of depression on postoperative pain and functional outcomes. METHODS We queried PubMed/MEDLINE and identified six clinical studies that evaluated the influence of a psychiatric diagnosis of depression on patient outcomes after TSA. Studies that discussed the impacts of depression on TSA, including PROs or adverse events in adults, were included. Studies focused on other psychologic pathology, non-TSA shoulder treatments, or TSA not for primary osteoarthritis were excluded. Non-clinical studies, systematic reviews, letters to the editor, commentaries, dissertations, books, and book chapters were excluded. RESULTS Three cohort studies described patient-reported pain and functional outcomes and three database studies assessed the risk of postoperative complications. Cohort studies demonstrated that the prevalence of depression in patients undergoing TSA decreased from preoperatively to 12-months postoperatively. Two studies demonstrated that depression is an independent predictor of less pre- to postoperative improvement in the ASES score at minimum 2-year follow-up; however, one study found the difference between patients with and without depression did not exceed the minimum clinically important difference. Database studies demonstrated that depression was associated with higher rates of blood transfusion (n = 1, OR = 1.8), anemia (n = 1, OR = 1.65), wound infection (n = 2, OR = 1.41-2.09), prosthetic revision (n = 1, OR = 1.92), and length of hospital stay (n = 3, LOS = 2.5-3 days). CONCLUSION Although patients with a preoperative diagnosis of depression undergoing TSA can achieve satisfactory relief of shoulder pain and restoration of function, they may experience poorer patient-reported outcomes and a higher risk of postoperative adverse events compared to their peers. Surgeons should be cognizant of the influence of depression in their patients to facilitate proper patient selection that maximizes patient satisfaction, function, and minimizes the risk of adverse events following TSA. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Victoria E Bindi
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Keegan M Hones
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Bradley S Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Hailey L Hampton
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Thomas W Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
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Pelet S, Hardy A, Tremblay F, Lechasseur B, Rivard-Cloutier M. Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures: A Prospective Cohort Study. J Orthop Trauma 2023; 37:e429-e434. [PMID: 37448159 DOI: 10.1097/bot.0000000000002660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To identify patient-related factors and fracture characteristics influencing the functional outcomes of nonoperatively treated radial head fractures and to determine function at 1 year. DESIGN Prospective cohort study. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016. INTERVENTION Nonoperative treatment of isolated radial head fractures. OUTCOME MEASUREMENTS Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and range of motion at 1.5-3-6-12 months. RESULTS One hundred fourteen patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3], and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with, respectively, 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups ( P < 0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1 year ( P < 0.05). CONCLUSIONS Although most nonoperatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1 year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow for interventions that may optimize function. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stéphane Pelet
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
- Centre de recherche FRQS du CHU de Québec, Québec, QC, Canada
| | - Alexandre Hardy
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Félix Tremblay
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Benoît Lechasseur
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
| | - Maude Rivard-Cloutier
- Department of Orthopedic Surgery, CHU de Québec-Hôpital Enfant-Jésus, Québec, QC, Canada; and
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3
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McQuillan TJ, Bernstein DN, Merchan N, Franco J, Nessralla CJ, Harper CM, Rozental TD. The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year. J Hand Surg Am 2022; 47:1166-1171. [PMID: 36319499 DOI: 10.1016/j.jhsa.2022.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/14/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Depression has been linked to inferior clinical outcomes among upper extremity patients. It often is challenging to distinguish the symptoms of depression, symptoms of injury, and the interaction between these 2 entities after a patient has been injured. We aimed to study the differences in clinical outcomes after surgical fixation of distal radius fractures between patients with and without a documented history and treatment for depression. METHODS All subjects with an isolated, acute distal radius fracture undergoing operative fixation in a 10-year period at a level 1 academic trauma center were screened. Baseline demographic data were collected, and psychiatric history and antidepressant use were recorded and verified with a pharmacy database. Quick Disability of the Arm, Shoulder and Hand (QuickDASH), range of motion, and grip strength were assessed at 12 months after surgery. Multivariable linear regression analysis was used to assess the association of depression with QuickDASH scores at 1 year after surgery. RESULTS A total of 211 patients were available for 1-year follow-up, 50 of whom were being treated actively for depression with medication at the time of injury and 161 were without a known diagnosis of, or treatment for, depression. Demographic and injury characteristics were similar between both groups. In a multivariable linear regression model controlling for age, sex, and a history of osteoporosis, active treatment for depression was associated with a slight mean increase in QuickDASH scores, 6.5 (1.3-11.8), 1 year after surgery. CONCLUSIONS This study demonstrates a small increase in QuickDASH scores between subjects with a confirmed diagnoses of depression compared with all others after surgical fixation of distal radius fracture at 1-year follow-up. We suggest that a history of depression may portend worse clinical outcomes, although other factors, such as underreporting of depression may influence results. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
| | | | - Nelson Merchan
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA
| | | | | | - Carl M Harper
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA
| | - Tamara D Rozental
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA.
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4
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Rolls C, Van der Windt DA, McCabe C, Babatunde OO, Bradshaw E. Prognostic factors for persistent pain after a distal radius fracture: a systematic review. HAND THERAPY 2022; 27:123-136. [PMID: 37904895 PMCID: PMC10584063 DOI: 10.1177/17589983221124973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 11/01/2023]
Abstract
Introduction The aim of this systematic review was to synthesize the evidence regarding prognostic factors for persistent pain, including Complex Regional Pain Syndrome (CRPS), after a distal radius fracture (DRF), a common condition after which persistent pain can develop. Methods Medline, Pubmed, Embase, Psychinfo, CINAHL, BNI, AMED and the Cochrane Register of Clinical Trials were searched from inception to May 2021 for prospective longitudinal prognostic factor studies investigating persistent pain in adults who had sustained a DRF. The Quality in Prognostic Studies (QUIPS) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were used to assess the strength of evidence. Results A search yielded 440 studies of which 7 studies met full eligibility criteria. From five studies we found low evidence for high baseline pain or an ulnar styloid fracture as prognostic factors for persistent pain, and very low evidence for diabetes or older age. From two studies, investigating an outcome of CRPS, there was low evidence for high baseline pain, slow reaction time, dysynchiria, swelling and catastrophising as prognostic factors, and very low evidence for depression. Sex was found not to be a prognostic factor for CRPS or persistent pain. Conclusions The associations between prognostic factors and persistent pain following a DRF are unclear. The small number of factors investigated in more than one study, along with poor reporting and methodological limitations contributed to an assessment of low to very low strength of evidence. Further prospective studies, investigating psychosocial factors as candidate predictors of multidimensional pain outcomes are recommended.
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Affiliation(s)
- Catherine Rolls
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Candy McCabe
- School for Health and Social Wellbeing, University West of England, Bristol, UK
| | | | - Elizabeth Bradshaw
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Swärd EM, Brodda-Jansen G, Schriever TU, Andersson-Franko M, Wilcke MK. The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis. J Hand Surg Eur Vol 2022; 47:805-811. [PMID: 35701996 PMCID: PMC9459353 DOI: 10.1177/17531934221104603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome.Level of evidence: II.
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Affiliation(s)
- Elin M. Swärd
- Karolinska Institutet, Department of Clinical Science and
Education, Södersjukhuset, Stockholm, Sweden,Department of Hand Surgery Södersjukhuset, Stockholm,
Sweden,Elin M. Swärd, Handkirurgiska Kliniken
Södersjukhuset, Sjukhusbacken 10, 11883 Stockholm, Sweden.
| | - Gunilla Brodda-Jansen
- Karolinska Institutet, Department of Clinical Sciences, Division
of Rehabilitation Medicine, Danderyd University Hospital, Stockholm,
Sweden
| | - Thorsten U. Schriever
- Karolinska Institutet, Department of Clinical Science and
Education, Södersjukhuset, Stockholm, Sweden,Department of Hand Surgery Södersjukhuset, Stockholm,
Sweden
| | - Mikael Andersson-Franko
- Karolinska Institutet, Department of Clinical Science and
Education, Södersjukhuset, Stockholm, Sweden
| | - Maria K. Wilcke
- Karolinska Institutet, Department of Clinical Science and
Education, Södersjukhuset, Stockholm, Sweden,Department of Hand Surgery Södersjukhuset, Stockholm,
Sweden
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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Grandizio LC, Choe LJ, Follett L, Laychur A, Young A. The impact of self-efficacy on nonoperative treatment of atraumatic shoulder pain. J Osteopath Med 2022; 122:297-302. [PMID: 35218332 DOI: 10.1515/jom-2021-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Atraumatic shoulder pain is frequently encountered in primary care and surgical clinics. With increased recognition of the biopsychosocial model, there has been an increased emphasis on identifying patient factors associated with less effective coping strategies such as pain catastrophizing. It remains uncertain what impact self-efficacy has on the response to nonoperative treatment of shoulder pain. OBJECTIVES Our purpose is to determine the influence of patient coping strategies (self-efficacy) on the outcome of nonoperative treatment of atraumatic shoulder pain. We hypothesize that higher levels of self-efficacy are associated with increased self-reported function after nonoperative treatment. METHODS We conducted a retrospective case-control study for a consecutive series of patients seen in our clinic with nonoperatively managed atraumatic shoulder pain. Baseline demographics and range of motion were recorded. Patients completed the Simple Shoulder Test (SST), PROMIS Pain Interference (PI), and PROMIS Self-Efficacy for Managing Symptoms (SE). After 3 months of nonoperative treatment, patients were placed into two groups: patients who clinically improved (Group 1) and those that did not (Group 2), with clinical improvement defined as an increase of 2 or greater on the SST. RESULTS Seventy-eight patients returned for follow-up and completed all questionnaires. There were no statistically significant differences for age, sex, or tobacco use between the two groups. Half of the patients in our series had symptoms for >12 months, with rotator cuff syndrome being the most frequent diagnosis (40.0%). Patients in Group 1 had significantly higher PROMIS SE scores (42 vs. 39, p=0.0094) at initial evaluation. At 3-month follow-up, patients in Group 1 also had significantly lower Numeric Pain Rating Scale (NPRS) scores (4.5 vs. 6.5, p=0.0067), compared to Group 2. CONCLUSIONS Patients who experience clinical improvement with nonoperative treatment of atraumatic shoulder conditions demonstrate higher self-efficacy than patients who fail to improve. Guiding patients with atraumatic shoulder pain and low self-efficacy toward interventions aimed at improving coping strategies, rather than addressing musculoskeletal factors alone, may contribute to the goal of improving outcomes.
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Affiliation(s)
- Louis C Grandizio
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 100 N. Academy Avenue, Danville, PA, USA
| | - Lisa J Choe
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 100 N. Academy Avenue, Danville, PA, USA
| | - Lisa Follett
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 100 N. Academy Avenue, Danville, PA, USA
| | - Andrew Laychur
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 100 N. Academy Avenue, Danville, PA, USA
| | - Amanda Young
- Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, 100 N. Academy Avenue, Danville, PA, USA
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8
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Mahdavi M, Farzad M, Mehta SP, MacDermid JC, Vahedi M, Hosseini SA, Shafiee E, Farhoud AR. Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture. Musculoskelet Sci Pract 2022; 57:102474. [PMID: 34773896 DOI: 10.1016/j.msksp.2021.102474] [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: 05/16/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry. OBJECTIVES To examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors. METHODS Eighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC). RESULTS Higher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88). CONCLUSION The novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors.
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Affiliation(s)
- Mohammad Mahdavi
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saurabh P 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.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada; Co-director Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; Professor Rehabilitation Science McMaster University, Hamilton, ON, Canada.
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran.
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada.
| | - Amir Reza Farhoud
- Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Iran.
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9
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Broggi MS, Tahmid S, Hurt J, Kadakia RJ, Bariteau JT, Coleman MM. Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery. Foot Ankle Spec 2022:19386400211065967. [PMID: 35037505 DOI: 10.1177/19386400211065967] [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: 11/15/2022]
Abstract
BACKGROUND The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. METHODS This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. RESULTS In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). CONCLUSION Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Syed Tahmid
- Department of Orthopaedics, Emory University, Atlanta, Georgia
| | - John Hurt
- Department of Orthopaedics, Emory University, Atlanta, Georgia
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10
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Perskin CR, Maseda M, Konda SR, Ganta A, Egol KA. Major depressive disorder, when under treatment, may not affect functional outcomes in patients with tibial plateau fractures. Knee 2022; 34:141-146. [PMID: 34920233 DOI: 10.1016/j.knee.2021.11.014] [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: 07/12/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study is to determine if treated psychological depression is associated with poorer functional outcomes in patients who sustain tibial plateau fractures. METHODS Patients with a tibia plateau fracture were prospectively followed. Functional status was assessed using the Short Musculoskeletal Function Assessment (SMFA) at baseline (pre-injury), 3 months, 6 months, and 1 year post injury. Clinical outcomes were recorded at each follow up visit and radiographic outcomes were obtained from follow up radiographs. Records were reviewed to identify patients who were being treated for major depressive disorder (MDD). SMFA scores and clinical outcomes were compared between the depression and no depression cohorts. RESULTS 420 patients were treated for a tibial plateau fracture and the mean age was 50.83 ± 15.60 years. Forty-two (10%) patients with 42 fractures were being treated for MDD at the time of their fracture. Patients with MDD were older (p = 0.05) and were more likely female (p < 0.01). At baseline, the clinical depression cohort had worse Total SMFA scores compared to the non-depressed cohort (5.90 ± 14.41 vs. 2.69 ± 8.35, p < 0.01). There were no differences in total SMFA score or any SMFA subscores at 3, 6, and 12 months. The incidence of wound complications, reoperations, and radiographic outcomes also did not differ between the cohorts. CONCLUSION Despite patients with MDD reporting higher SMFA (poorer) scores at baseline, MDD was not associated with worse injuries, diminished clinical or poorer functional outcomes following tibial plateau fractures.
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Affiliation(s)
- Cody R Perskin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Meghan Maseda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, United States; Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Jamaica, NY, United States.
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11
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Cochrane SK, Calfee RP, Stonner MM, Dale AM. The relationship between depression, anxiety, and pain interference with therapy referral and utilization among patients with hand conditions. J Hand Ther 2022; 35:24-31. [PMID: 33250395 PMCID: PMC8985319 DOI: 10.1016/j.jht.2020.10.006] [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: 07/30/2019] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with upper extremity conditions may also experience symptoms of depression, anxiety, and pain that limit functional recovery. PURPOSE OF THE STUDY This study examined the impact of mental health and pain symptoms on referral rates to therapy and utilization of therapy services to achieve functional recovery among patients with common hand conditions. STUDY DESIGN This is a retrospective cohort study of patients from one orthopedic center. METHODS Data extraction provided demographics, the International Classification of Diseases, 10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression, Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS depression, anxiety, and pain interference to therapy referral, the number of therapy visits, and goal attainment. RESULTS Forty-nine percent (172/351) of patients were referred to hand therapy. There was no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average required one more therapy visit to achieve treatment goals (average visits: 3.7 vs 3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores (50%) achieved their long-term goals than patients with low depression scores (69%, P = .20). CONCLUSIONS Patients' baseline level of depressive symptoms and anxiety do not predict referrals to hand therapy by orthopedic hand surgeons. There is some indication that patients with increased depressive symptoms, anxiety, and pain interference require more therapy with fewer achieving all goals, suggesting that mental health status may affect response to therapy. Therapists may address mental health needs in treatment plans. Future studies should examine if nonreferred patients with depressive symptoms achieve maximal functional recovery.
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Affiliation(s)
- Shannon K. Cochrane
- Washington University School of Medicine in St. Louis, Program in Occupational Therapy, St. Louis, MO, USA
| | - Ryan P. Calfee
- Washington University School of Medicine in Saint Louis, Orthopedic Surgery, Saint Louis, MO, USA
| | - Macyn M. Stonner
- Washington University School of Medicine in St. Louis, Milliken Hand Rehabilitation Center, Center for Advanced Medicine, St. Louis, MO, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA,Corresponding author. Department of Medicine, Washington University School of Medicine in St. Louis, 4523 Clayton Ave., CB 8005, Saint Louis, MO 63110, USA. Tel.: 314-454-8470; fax: 314-454-5113. (A.M. Dale)
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12
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Zeidan M, Stephens AR, Zhang C, Presson AP, Kazmers NH. Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:235-239. [PMID: 34632351 PMCID: PMC8496877 DOI: 10.1016/j.jhsg.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on mid-term outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF. Methods Adult patients (≥18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at ≥1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score. Results Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern. Conclusions At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation. Type of study/level of evidence Prognostic IV.
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Affiliation(s)
- Michelle Zeidan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | | | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
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Ludvigsen T, Matre K, Vetti N, Kristoffersen PM, Toppe MK, Gudmundsdottir R, Krukhaug Y, Dybvik E, Fevang JM. Is there a correlation between functional results and radiographic findings in patients with distal radius fracture A0 type A3 treated with volar locking plate or external fixator? OTA Int 2021; 4:e142. [PMID: 34746674 PMCID: PMC8568390 DOI: 10.1097/oi9.0000000000000142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED The aim of this study was to test the hypothesis that precise restoration of distal radius fractures is correlated to better patient-reported outcome. METHODS The correlation between radiographic results and functional outcome was explored in 156 patients with extra-articular distal radius fractures included in a multicenter, randomized controlled trial comparing 2 surgical interventions, Volar Locking Plate or External Fixator. The primary functional outcome was the Patient Rated Wrist and Hand Evaluation score (PRWHE). Radiographically we assessed volar tilt, radial inclination, radial height, ulnar variance, and the presence of ulnar styloid fracture. The Pearson correlation analysis was used to estimate correlations between parameters. RESULTS At 1-year follow-up the mean difference in radiographic findings compared with the uninjured side (min, max) was: reduced volar tilt 5.3° (-15°, 25°), reduced radial inclination 2.3° (-6°, 12°), radial height 1.3 mm (-4 mm, 7 mm), and ulnar variance -0.5 mm (-6 mm, 3 mm). Overall, we found no correlation between radiographic parameters and the PRWHE at 1-year follow-up within the whole group, regardless of which treatment was chosen. At the time of injury 53% (N = 80) had sustained an additional ulnar styloid fracture. After 1 year this fracture was still radiographically present in 31% (N = 43) of the patients. No correlation between PRWHE score and the presence of an ulnar styloid fracture at 1-year follow-up was found. CONCLUSIONS We found no correlation between functional outcome (PRWHE) and radiographic findings after 1 year in patients operated on with a Volar Locking Plate or External Fixator. Patient-specific factors were more important than radiographic measurements in this study group.Level of evidence: Therapeutic Level 2Trial registration: Norway: National Committee for Medical and Health Research Ethics 213/555ClinicalTrials.gov ID: NCT01904084Randomization of first patient: 02.09.2013.
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Affiliation(s)
- Trine Ludvigsen
- University of Bergen, Bergen
- Orthopaedic Department, Voss Hospital, Voss
| | - Kjell Matre
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
| | - Nils Vetti
- University of Bergen, Bergen
- Radiology Department
| | | | | | | | - Yngvar Krukhaug
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
| | - Eva Dybvik
- Norwegian National Advisory Unit on Arthroplasty and Hip Fractures, Bergen, Norway
| | - Jonas Meling Fevang
- University of Bergen, Bergen
- Orthopaedic Department, Haukeland University Hospital
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Grandizio LC, Gehrman MD, Graham J, Dwyer CL, Sharma J, Goldberg S, Klena JC. The Ability of Upper Extremity Surgeons to Assess Patient's Functional Status. J Hand Surg Am 2021; 46:819.e1-819.e8. [PMID: 33846024 DOI: 10.1016/j.jhsa.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 11/25/2020] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare surgeon and patient assessment of upper extremity functional status at the time of initial consultation. We hypothesized that surgeons and patients demonstrate low levels of agreement with respect to assessing pain scores, functional status, and self-efficacy. METHODS One hundred forty-three consecutive new patients were evaluated by 1 of 5 fellowship-trained upper extremity surgeons. Patients completed a Numeric Pain Rating Scale as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Pain Interference (PI), and Self-Efficacy (SE) instruments. Surgeons provided their own estimates of patient function on each questionnaire at the conclusion of the visit and were blinded to the results of the patient-reported outcome measures (PROMs) for the duration of the study. Estimation errors, which represent the absolute value of the difference between the patient's actual score and the surgeon's estimated score on each questionnaire, were calculated for each questionnaire. RESULTS As a group, surgeons assumed that the PROMIS UE and SE scores were higher than the patients' actual scores and assumed that patients had lower PROMIS PI scores than were actually reported. Mean estimation errors for all PROMIS instruments were greater than 10 points and larger than the SD for these instruments in the general population. CONCLUSIONS Upper extremity surgeons demonstrate difficulty assessing their patient's self-reported functional status, pain interference, and level of self-efficacy during initial consultations. CLINICAL RELEVANCE Although formalized PROMs are infrequently administered in orthopedic clinics, increased utilization of these questionnaires would allow for a more accurate baseline functional assessment. When evaluating new patients in the outpatient clinic, surgeons should recognize the potential limitations of their assessments of patient-reported function.
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Affiliation(s)
- Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA.
| | - Max D Gehrman
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Jove Graham
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - C Liam Dwyer
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Jyoti Sharma
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Steven Goldberg
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA
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15
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Kim JK, Al-Dhafer B, Shin YH, Joo HS. Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture. J Hand Ther 2021; 36:97-102. [PMID: 34253407 DOI: 10.1016/j.jht.2021.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures. PURPOSE The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs). STUDY DESIGN Prospective cohort study METHODS: For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire. RESULTS The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance. CONCLUSIONS In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group.
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Affiliation(s)
- Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Bassmh Al-Dhafer
- Department of Orthopedic Surgery, King Faisal University, Kingdom of Saudi Arabia
| | - Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Seok Joo
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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McQuillan TJ, Franco JR, Sorg EM, Baller E, Quijije N, Rozental TD. Understanding and Addressing Psychiatric Comorbidities and Upper-Extremity Trauma: Surgeons in a Multidisciplinary Care Model. J Hand Surg Am 2021; 46:328-334. [PMID: 33637395 DOI: 10.1016/j.jhsa.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/23/2020] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
Psychiatric disorders are a common cause of disability and represent an important risk factor for upper-extremity trauma. The review provides an overview of psychiatric illnesses as both contributors and sequelae of 4 major injury patterns: self-inflicted wrist lacerations, self-amputation, upper-extremity fractures, and burns. The authors develop a multidisciplinary model for upper-extremity surgeons to care for patients with psychiatric disorders, with an overview of capacity assessment, optimal psychiatric comanagement, and collaboration with allied health professionals.
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Affiliation(s)
| | | | - Emily M Sorg
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Erica Baller
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nadia Quijije
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Tamara D Rozental
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess, Boston, MA.
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17
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Stephens AR, Presson AP, McFarland MM, Zhang C, Sirniö K, Mulders MA, Schep NW, Tyser AR, Kazmers NH. Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Bone Joint Surg Am 2020; 102:1280-1288. [PMID: 32675679 PMCID: PMC7431141 DOI: 10.2106/jbjs.19.01442] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It remains unclear whether volar locked plating (VLP) yields a better functional outcome than closed reduction and casting (CRC) for elderly patients with an acute, displaced distal radial fracture. Our purpose was to conduct a systematic review and meta-analysis of randomized controlled trials comparing outcomes of VLP and CRC for elderly patients (age, ≥60 years). METHODS Multiple databases, including MEDLINE, were searched for randomized controlled trials evaluating outcomes following distal radial fracture treatment. Raw data were obtained for studies that included patients of all ages, and the elderly subgroup was included for analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at ≥1 year of follow-up. Secondary outcomes included the 3-month DASH score, range of motion, final radiographic alignment, and complications. Effect sizes for the comparison of each outcome between groups were pooled across studies using random-effects models with the inverse variance weighting method. Changes in DASH score were compared with a minimal clinically important difference (MCID) estimate of 10 to assess clinical relevance. RESULTS Of 2,152 screened articles, 6 were included. Demographics were similar for the 274 VLP and 287 CRC patients. DASH scores were significantly better following VLP than CRC at the time of final follow-up (12 to 24 months postoperatively; score difference, -5.9; 95% confidence interval [CI], -8.7 to -3.1) and at 3 months (-8.9; 95% CI, -13.0 to -4.8). VLP yielded significantly better palmar tilt, radial inclination, and supination, with no differences in ulnar variance, flexion-extension, pronation, or total complication rates. CONCLUSIONS Functional outcome was significantly better following VLP than CRC 3 months into the treatment of acute, displaced distal radial fractures in an elderly population and up to 2 years after injury. However, the observed differences in the final DASH score did not exceed published estimates of the MCID, suggesting that clinical outcomes are similar for both treatment options. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew R. Stephens
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Mary M. McFarland
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Kai Sirniö
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Andrew R. Tyser
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
| | - Nikolas H. Kazmers
- Division of Public Health (A.P.P. and C.Z.), Eccles Health Sciences Library (M.M.M.), Department of Orthopaedics (A.R.T. and N.H.K.), and School of Medicine (A.R.S.), University of Utah, Salt Lake City, Utah
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18
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Sh Ahmed O, Cinotto G, Boczar D, Huayllani MT, Trigg SD, Forte AJ, McVeigh K. Defining Outcomes Following Distal Radius Fractures: Correlation of Function, Pain, and Hand Therapy Utilization. Cureus 2020; 12:e8718. [PMID: 32699713 PMCID: PMC7372198 DOI: 10.7759/cureus.8718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Distal radius fractures (DRF) is one of the most common fractures in clinical practice. Our objective was to study the role of early hand therapy and its impact on pain and return to daily activities. Methods The charts of patients with DRFs seen between January 2016 and November 2017 in the Hand Center of Mayo Clinic Florida were reviewed retrospectively. Forty-nine patients with DRFs who met inclusion criteria were included in the analysis. The variables collected included: age, gender, side of the fracture, surgery vs non-surgery, time to start hand therapy, number of visits, shortened disabilities of the arm, shoulder, and hand (QuickDASH) initial and discharge scores, and visual analog scale (VAS) initial and discharge. Results The patients’ mean age was 67.90 years, (standard deviation (SD) 14.54), 38 (77.6%) were female, 28 (57.1%) had a right DRF, 21 (42.9%) had a left DRF, 38 (77.6%) had no surgery, 11 (22.4%) had surgery. The mean time from fracture to therapy is 32.41, (SD 24.13) days, and the mean total number of visits is 6.20 (SD 3.49). We noticed a statistically significant difference between the initial QuickDASH (59.27, SD 16.93) compared to the discharge QuickDASH (24.08, SD 12.77) (P-value <.001); and initial VAS (3.57, SD 1.71) with a discharge VAS (1.33, SD 0.97) (P-value <.001). Conclusion This retrospective study found a statistically significant reduction in the QuickDASH and VAS scores after six hand therapy visits. The results suggest that early rehabilitation interventions lead to improvements in pain and return to daily activity following DRF.
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Affiliation(s)
- Omar Sh Ahmed
- Cancer Clinical Studies Unit, Mayo Clinic Florida, Jacksonville, USA
| | - Gabriela Cinotto
- Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | - Daniel Boczar
- Plastic Surgery, Mayo Clinic Florida, Jacksonville, USA
| | | | - Stephen D Trigg
- Orthopaedics, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA
| | | | - Kimberly McVeigh
- Physical Medicine and Rehabilitation, Mayo Clinic Florida, Jacksonville, USA
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Simske NM, Breslin MA, Hendrickson SB, Vallier HA. Are we missing the mark? Relationships of psychosocial issues to outcomes after injury: A review of OTA annual meeting presentations. OTA Int 2020; 3:e070. [PMID: 33937698 PMCID: PMC8022906 DOI: 10.1097/oi9.0000000000000070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To observe the availability of information about social, emotional, and psychological factors in abstracts presented at the Orthopaedic Trauma Association (OTA) annual meeting. DATA SOURCE OTA website (https://ota.org/education/meetings-and-courses/meeting-archive/). STUDY SELECTION All abstracts selected for paper or poster presentation at the 2016 through 2018 OTA annual meetings, as published in the final program. Studies were included if they sought to measure mental illness, substance use or abuse, pain, or other psychosocial issues. If studies utilized 1 or more patient-reported outcome measures (PROMs), they were also included. DATA EXTRACTION For each abstract meeting inclusion criterion, studies were assessed for interventions intended to improve outcomes in any of the listed psychosocial domains. DATA SYNTHESIS/RESULTS Nine hundred forty-two abstracts were evaluated over a 3-year period. Of these, 294 (31.2%) met inclusion criteria. Twenty-five abstracts (8.5% of 294) reported mental illness, with depression (n = 14), anxiety (n = 9), and posttraumatic stress disorder (n = 5) being the most common. Eighty-eight abstracts (29.9% of 294) reported substance-use of tobacco, alcohol, narcotics, and/or recreational drugs. Tobacco-use was most prevalent (n = 59), followed by opioid-use (n = 31). Ten abstracts reported substance abuse. Pain was measured in 95 abstracts, and 203 abstracts utilized PROMs. Thirty-five abstracts found that these psychosocial elements significantly impacted outcomes or complications. Many abstracts did not assess the influence of these factors on clinical outcomes (n = 99). Sixteen studies described an intervention aimed at mitigating these features. CONCLUSIONS This study illustrates limited attention to the impact of psychological, social, and environmental factors on outcomes after orthopaedic trauma. Substance-abuse problems and mental health concerns are not only predictors of poor clinical and PROMs of pain and quality of life after injury, but have also been implicated in subsequent recidivism. Only 3% of 942 abstracts observed mental health and 1% reported substance-abuse. Moving forward, greater understanding of psychosocial issues may enhance interventions to impact long-term outcomes.
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Affiliation(s)
- Natasha M Simske
- MetroHealth Medical Center, Cleveland, Ohio, affiliated with Case Western Reserve University
| | - Mary A Breslin
- MetroHealth Medical Center, Cleveland, Ohio, affiliated with Case Western Reserve University
| | - Sarah B Hendrickson
- MetroHealth Medical Center, Cleveland, Ohio, affiliated with Case Western Reserve University
| | - Heather A Vallier
- MetroHealth Medical Center, Cleveland, Ohio, affiliated with Case Western Reserve University
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Raittio L, Launonen AP, Hevonkorpi T, Luokkala T, Kukkonen J, Reito A, Laitinen MK, Mattila VM. Two casting methods compared in patients with Colles' fracture: A pragmatic, randomized controlled trial. PLoS One 2020; 15:e0232153. [PMID: 32469881 PMCID: PMC7259650 DOI: 10.1371/journal.pone.0232153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Distal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients. Methods and findings We performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65–94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.– 3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16–2.1). Conclusion In this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly patients at 12-month follow-up. However, the functional cast is more likely to be superior when compared to volar-flexion and ulnar deviation cast. Trial registration ClinicalTrials.gov identifier: NCT02894983 Accessible: https://clinicaltrials.gov/ct2/show/NCT02894983
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Affiliation(s)
- Lauri Raittio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- * E-mail:
| | - Antti P. Launonen
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Teemu Hevonkorpi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Toni Luokkala
- Central Finland Central Hospital, Jyväskylä, Finland
| | | | - Aleksi Reito
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
| | - Minna K. Laitinen
- Division of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
- Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ville M. Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, Tampere, Finland
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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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Simske NM, Rivera T, Breslin MA, Hendrickson SB, Simpson M, Kalina M, Ho VP, Vallier HA. Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period. Trauma Surg Acute Care Open 2020; 5:e000363. [PMID: 32072016 PMCID: PMC6996789 DOI: 10.1136/tsaco-2019-000363] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources. METHODS Trauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient's medical records. RESULTS From May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had 'direct contact' (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2-15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2-10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018. CONCLUSIONS Hospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary. LEVEL OF EVIDENCE Level II therapeutic.
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Affiliation(s)
| | - Trenton Rivera
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mary A Breslin
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | | | - Megen Simpson
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Mark Kalina
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
| | - Vanessa P Ho
- Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Predicting completion of follow-up in prospective orthopaedic trauma research. OTA Int 2019; 2:e047. [PMID: 33937675 PMCID: PMC7997129 DOI: 10.1097/oi9.0000000000000047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/06/2019] [Indexed: 11/29/2022]
Abstract
Objective: Orthopaedic trauma studies that collect long-term outcomes are expensive and maintaining high rates of follow-up can be challenging. Knowing what factors influence completion of follow-up could allow interventions to improve this. We aimed to assess which factors influence completion of follow-up in the 12 months following surgery in prospective orthopaedic trauma research. Design: Prospective Cohort Study. Setting: Level 1 Trauma Center, Vancouver, Canada. Participants: Eight hundred seventy patients recruited to 4 prospective studies investigating the outcomes of operatively treated lower extremity fractures. Main outcome measurements: Completion of follow-up defined as completion of all outcome measures at all time points up to 12 months following injury. Results: Univariate analysis and subsequent analysis by building a reductive multivariate regression model allowed for estimation of the influence of factors in completion of follow-up. Eight hundred seventy patients with complete data had previously been recruited and were included in the analysis. Seven hundred seven patients (81.2%) completed follow-up to 12 months. Factors associated with completion of follow up included higher physical component score of SF-36 at baseline, not being on social assistance at the time of injury, being married and having a higher level of educational attainment. Conclusions: Our study has demonstrated several important factors identifiable at baseline which are associated with a failure to complete follow-up. Although these factors are not modifiable themselves, we advocate that researchers designing studies should plan for additional follow-up resources and interventions for at risk patients. Level of Evidence: Level IV
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Chen YP, Huang YY, Wu Y, Kuo YJ, Lin CY. Depression negatively affects patient-reported knee functional outcome after intraarticular hyaluronic acid injection among geriatric patients with knee osteoarthritis. J Orthop Surg Res 2019; 14:387. [PMID: 31775836 PMCID: PMC6882243 DOI: 10.1186/s13018-019-1419-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Intraarticular hyaluronic acid injection (IAHA) is a popular treatment for knee osteoarthritis (OA). This study investigates whether depression, anxiety, and pain affect self-reported knee function in geriatric OA people who have received IAHA. METHODS Through convenience sampling, 102 geriatric patients (mean age = 70.91 ± 7.19; 28 males) with knee OA who had undergone IAHA participated in this study. All participants self-reported depression using the Geriatric Depression Scale (GDS), anxiety using the State-Trait Anxiety Inventory (STAI), knee function using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee subjective knee evaluation form (IKDC), and pain severity using the Visual Analogue Scale (VAS). They completed the aforementioned questionnaires at baseline before injection and then again at 2-, 4-, and 6-month follow-ups. RESULTS Depression was significantly associated with IKDC, WOMAC physical function subscale, and total WOMAC scores. Anxiety was only significantly associated with the WOMAC pain subscale score. Pain severity was significantly associated with IKDC, WOMAC stiffness subscale, WOMAC physical function subscale, and total WOMAC scores. CONCLUSION Given that depression negatively affected patient-reported knee function among geriatric OA patients who had undergone IAHA, further attention should be paid to the depressive status of this population.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Yun Huang
- Graduate Institute of Nursing- Linkou campus, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yueh Wu
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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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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Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract 2019; 43:96-102. [PMID: 31374477 DOI: 10.1016/j.msksp.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.
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Affiliation(s)
- Shirin Modarresi
- Health & Rehabilitation Science, Western University, London, ON, Canada.
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada; School of Physical Therapy, Western University, London, ON, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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Chung KC, Kim HM, Malay S, Shauver MJ. Predicting Outcomes After Distal Radius Fracture: A 24-Center International Clinical Trial of Older Adults. J Hand Surg Am 2019; 44:762-771. [PMID: 31345563 DOI: 10.1016/j.jhsa.2019.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Current evidence on predictors of outcomes after distal radius fracture is often based on retrospective analyses or may be confounded by fracture type. Using data from the Wrist and Radius Injury Surgical Trial (WRIST), a 24-site randomized study of distal radius fracture treatment, in which all fractures are severe enough to warrant surgery, we set out to perform a secondary data analysis to explore predictors of better or worse hand outcomes. METHODS The primary outcome measure was the Michigan Hand Outcomes Questionnaire (MHQ) summary score 12 months after treatment. We used a regression tree analysis with recursive partitioning to identify subgroups of participants who experienced similar outcomes (ie, MHQ score) and to determine which baseline or treatment factors they had in common. RESULTS Factors most predictive of 12-month MHQ score were pain at enrollment, education, age, and number of comorbidities. Specifically, participants who had a high school education or less and also reported severe pain had the lowest MHQ scores. Conversely, participants with less pain and more education and who were age 87 years or younger with one or no comorbid condition had the highest MHQ scores. Treatment type or radiographic measurements assessed on post-reduction films did not affect 12-month outcomes. CONCLUSIONS These results identified patient characteristics that can be used by surgeons to identify subgroups of patients who may experience similar hand outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
| | - H Myra Kim
- Center for Statistical Consulting and Research
| | - Sunitha Malay
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Melissa J Shauver
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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Effect of Mental Health Conditions on Complications, Revision Rates, and Readmission Rates Following Femoral Shaft, Tibial Shaft, and Pilon Fracture. J Orthop Trauma 2019; 33:e210-e214. [PMID: 31125328 DOI: 10.1097/bot.0000000000001438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the effect of pre-existing mental health (MH) conditions on 90-day complication, 90-day readmission, and all-time revision surgical intervention rates following femoral, tibial, and pilon fractures. DESIGN Data were collected using a commercially available database software for which Current Procedural Terminology codes were used to identify patients who underwent surgical treatment of tibial, femoral, or pilon fractures. These patients were then subdivided into those with and without pre-existing MH condition using International Classification of Disease, Ninth Edition codes. Ninety-day postoperative complications, revision surgery, and 90-day readmission rates were then compared between those with and without MH conditions. SETTING National databases of 70 million combined patients from 2007 to 2015. PATIENTS/PARTICIPANTS Humana and Medicare insured patients. INTERVENTION Surgical treatment of tibial, femoral, and pilon fractures. MAIN OUTCOME MEASUREMENTS Ninety-day readmission, 90-day complications, and all-time revision surgical intervention. RESULTS The total number of patients for femoral, tibial, and pilon treatment, respectively, included 6207, 6253, and 5940 without MH conditions and 4879, 5247, and 2911 with MH conditions. Femoral, tibial, and pilon readmission rates, revision rates, and complication rates were significantly higher among patients with MH disorders in matched cohorts after controlling for medical comorbidities (P ≤ 0.05 for all). CONCLUSIONS Comorbid MH conditions are associated with higher postoperative complication, readmission, and revision surgery rates for treated femoral, tibial, and pilon fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Simske NM, Audet MA, Kim CY, Benedick A, Vallier HA. Mental illness is associated with more pain and worse functional outcomes after ankle fracture. OTA Int 2019; 2:e037. [PMID: 37662834 PMCID: PMC10473302 DOI: 10.1097/oi9.0000000000000037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/26/2019] [Indexed: 09/05/2023]
Abstract
Objectives To assess clinical and functional outcomes after ankle fracture in patients with preexisting mental illness. Design Retrospective study. Setting Level 1 trauma center. Patients/Participants One thousand three hundred seventy-eight adult patients treated for ankle fractures; 228 (17%) had preexisting mental illness. Intervention Open reduction internal fixation. Main outcome measure Rates of complications and reoperations. Functional outcomes were assessed via Foot Function Index (n = 530) and Short Musculoskeletal Function Assessment (n = 530). Results Depression was the most common mental illness (63%), followed by anxiety (23%). Mental illness was associated with older age, female sex, and preexisting medical comorbidities, including diabetes and obesity. Mental illness was not associated with specific fracture patterns or open injury. Complications occurred no more often in patients with mental illness, but secondary operations (13% vs 7%) were more likely, particularly implant removals (8% vs 4%), both P < .05. Functional outcomes were worse in mentally ill patients as measured by the Foot Function Index (39 vs 30, P = .006) and Short Musculoskeletal Function Assessment Mobility: 45 vs 35, Bothersome: 35 vs 26 and Dysfunction: 35 vs 26, all P < .01. Conclusion Secondary operations were nearly 50% more frequent in patients with mental illness, and functional outcome scores were significantly worse, suggesting that mental illness, unrelated to injury and treatment parameters, has major influence on outcomes. In the future, strategies to identify and treat mental illness prior to and after treatment could improve functional outcomes following ankle fracture.
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Affiliation(s)
- Natasha M Simske
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Megan A Audet
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Chang-Yeon Kim
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Alex Benedick
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
| | - Heather A Vallier
- MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, Ohio
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Using Patient-reported Outcomes Measurement Information System Measures to Understand the Relationship Between Improvement in Physical Function and Depressive Symptoms. J Am Acad Orthop Surg 2018; 26:e511-e518. [PMID: 30216242 PMCID: PMC6289818 DOI: 10.5435/jaaos-d-17-00039] [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] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This investigation determined whether improved physical function and decreased pain would reduce depressive symptoms using the Patient-reported Outcomes Measurement Information System (PROMIS). METHODS This cohort study analyzed PROMIS Depression, Physical Function, and Pain Interference CAT scores from 3,339 patients presenting to a tertiary orthopaedic center. Patients demonstrating at least a-five point (effect size, 0.5) improvement in PROMIS Physical Function between consecutive visits were eligible for inclusion. RESULTS Patients presented, on average, with Physical Function and Pain Interference scores nearly one SD worse than population averages and Depression scores that approximated the normal population. Improved Physical Function and Pain Interference scores demonstrated no correlation with change in Depression scores (r = -0.13; r = 0.25). CONCLUSION Substantial early improvement in PROMIS Physical Function scores is not associated with change in PROMIS Depression scores. PROMIS Depression scores likely reflect underlying mental health rather than situational depressive symptoms. LEVEL OF EVIDENCE Prognostic, level III.
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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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