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Therrien CC, Ten Duis K, Banierink H, de Vries JPPM, Reininga IHF, IJpma FFA. Is patient-reported outcome after treatment of unstable pelvic ring injuries related to pelvic symmetry? A prospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02652-2. [PMID: 39190066 DOI: 10.1007/s00068-024-02652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE To determine the relation between pelvic symmetry, as measured by the cross-measurement technique, and patient-reported outcome measures (PROMs) in terms of functional status and health-related quality of life. METHODS In this prospective cohort study, X and Y measurements were taken according to the cross-measurement technique on AP radiographs of patients who were treated for an unstable pelvic ring injury in a level-1 trauma center. Patients completed PROMs at the time of admission (recalled pre-injury score) and one year following their injury, reporting their functional status with the Short Musculoskeletal Function Assessment (SMFA-NL), specifically the lower extremity dysfunction (LED), problems with daily activities (PDA) and mental and emotional problems (MEP) subscales, and quality of life with EuroQol-5D (EQ-5D). Subgroup analyses were also performed. PROMs were used to analyze the relation between pelvic symmetry and patient-reported outcome, using Spearman's Rank correlation coefficients. RESULTS A total of 130 patients (mean age 58 (SD18) years) with an unstable pelvic ring injury were included, of which 95 (73%) sustained type-B injuries and 35 (27%) type-C injuries. Sixty-three (49%) patients were treated operatively. The median pelvic symmetry ratio was 1.01 (IQR: 0.05). Weak or no correlations were found between the pelvic symmetry scores and the outcome measurements (Spearman's correlation coefficients: LED r = 0.09; PDA r = 0.11; MEP r=-0.02; and EQ-5D r=-0.08). Subgroup analyses revealed no correlations. CONCLUSIONS No significant relation was found between pelvic symmetry, measured radiologically, and functional status and health-related quality of life, one year following an unstable pelvic ring injury.
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Affiliation(s)
- Camryn C Therrien
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Kaj Ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hester Banierink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Chan JJ, Xiao RC, Hasija R, Huang HH, Kim JM. Epidemiology of Hand and Wrist Injuries in Collegiate-Level Athletes in the United States. J Hand Surg Am 2023; 48:307.e1-307.e7. [PMID: 34895779 DOI: 10.1016/j.jhsa.2021.10.011] [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: 06/07/2020] [Revised: 08/26/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Hand and wrist injuries are common among competitive athletes and can have a substantial impact on playing time and future participation. The purpose of this study was to provide epidemiological data from the National Collegiate Athletic Association Injury Surveillance Program to correlate injury diagnosis with the need for surgery and time loss. METHODS Using the National Collegiate Athletic Association Injury Surveillance Program, this retrospective study extracted data of hand and wrist injuries for all 25 National Collegiate Athletic Association sports from the academic years 2004-2005 to 2013-2014. The "severe" category was defined as injuries resulting in the following: (1) surgery, (2) season-ending status, or (3) more than 30 days of playing time loss. The epidemiologic data included injury rate per 100,000 athlete exposures (defined as 1 athlete participating in 1 practice or competition) based on diagnoses and demographic information such as sports and sex. We used a Poisson regression model to estimate the incidence rate and 95% confidence interval. RESULTS Overall, 4,851 hand injuries were identified, with an injury rate of 41.2 per 100,000 athlete exposures. The most common diagnoses were metacarpal or phalangeal fractures (19.9%), lacerations or contusions (15.4%), and wrist sprains (14.7%). The surgical rate was 9.6%, and the season-ending rate was 5.8%. Severe injuries occurred in 17.5% of the hand and wrist injuries; within this subset, the most common diagnoses included metacarpal or phalangeal fractures (43.8%), scaphoid fractures (12.8%), and thumb ulnar collateral ligament tears (8.7%). Scaphoid fractures and metacarpal or phalangeal fractures had the highest surgical rate and season-ending rate among all the injuries. CONCLUSIONS The injury rate of hand and wrist injuries is comparable with those of other common sports injuries. Approximately one fifth of the injuries were considered severe, which led to a high surgical rate, and these had a considerable impact on the athletes' ability to finish the season. TYPE OF STUDY/LEVEL OF EVIDENCE Outcome research level II.
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Affiliation(s)
- Jimmy J Chan
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan C Xiao
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rohit Hasija
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaehon M Kim
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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Koziara K, Mijas ME, Galbarczyk A, Wycisk J, Pliczko MP, Krzych-Miłkowska K, Grabski B. It gets better with age: Resilience, stigma, and mental health among lesbian, gay, bisexual, transgender and queer persons from Poland. Front Psychol 2022; 13:958601. [PMID: 36204734 PMCID: PMC9531266 DOI: 10.3389/fpsyg.2022.958601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Lesbian, gay, bisexual, transgender, and queer populations are disproportionately affected by chronic stress associated with stigma which contributes to health adversities including depression. Negative impact of stigma on health can be alleviated by factors such as resilience. Little is known however on how exposure to stigma, protective factors and mental health change with age among gender and sexually diverse persons. Our study aimed at investigating this issue. Our sample consisted of (i) 245 sexually diverse cisgender women, (ii) 175 sexually diverse cisgender men, and (iii) 98 transgender and gender diverse persons. We collected data through a web-based survey. Linear regression models were performed to investigate the interactions of age and each group of participants for resilience, stigma exposure, and mental health indicators (depression and self-esteem). We hypothesized that resilience and mental health indicators will be positively associated with age in all distinguished groups despite the continued exposure to minority stress. The analysis yielded no significant relationships between stigma exposure and age among study participants. However, we observed significant interaction effects of distinguished groups of participants and age in case of self-esteem, depression, and resilience. Self-esteem and resilience were related positively, and depression was negatively associated with age in all study groups. Additionally, we observed that sexually diverse cisgender men demonstrated significantly increased resilience, reduced depression and higher self-esteem compared to other groups. Although the exposure to stigma did not decrease with age, resilience and self-esteem increased, suggesting that LGBTQ persons manage to thrive despite adversities.
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Affiliation(s)
- Karolina Koziara
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena E Mijas
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Jowita Wycisk
- Faculty of Psychology and Cognitive Sciences, Adam Mickiewicz University, Poznan, Poland
| | - Mateusz P Pliczko
- Sexology Lab, Department of Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Krzych-Miłkowska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Bartosz Grabski
- Sexology Lab, Department of Psychiatry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Nguyen C, Kortlever JT, Gonzalez AI, Crijns TJ, Ring D, Vagner GA, Reichel LM. Does Resiliency Mediate the Association of Psychological Adaptability with Limitations and Pain Intensity after Upper Extremity Trauma? THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:686-694. [PMID: 35106334 PMCID: PMC8765205 DOI: 10.22038/abjs.2021.51098.2533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Given the influence of psychosocial factors on musculoskeletal symptoms and limitations, this study assessed if the ability of resilience (an individual's ability to adapt under stress) mediates the association of psychological adaptability with magnitude of physical limitations and pain intensity during recovery from an upper extremity injury. METHODS A total of 107 patients were enrolled in this prospective, longitudinal, observational cohort study. Patients completed the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), an 11-point ordinal measure of pain intensity, the Brief Resilience Scale (BRS), and the Psychological Adaptation Scale (PAS). We used structural equation modeling to assess the mediation effect by resiliency and psychological adaptability on patient-reported disability and pain at initial assessment and after three months. RESULTS PAS and BRS were not independently associated with PROMIS PF or pain intensity at enrollment or after three months, so it was not possible to assess if resiliency mediated the association of psychological adaptability with physical function or pain. There were no factors independently associated with resilience. CONCLUSION General measures of psychological adaptability and resiliency do not correlate with symptoms and limitations as well as specific measures of adaptiveness in response to nociception.
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Affiliation(s)
- Cindy Nguyen
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - Joost T.P. Kortlever
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - Amanda I. Gonzalez
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - Tom J. Crijns
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - David Ring
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - Gregg A. Vagner
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
| | - Lee M. Reichel
- Department of Surgery and Perioperative Care Dell Medical School – The University of Texas at Austin,1701 Trinity Street, Austin, TX, 78705, USA
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Andrés-Romero MP, Flujas-Contreras JM, Fernández-Torres M, Gómez-Becerra I, Sánchez-López P. Analysis of Psychosocial Adjustment in the Family During Confinement: Problems and Habits of Children and Youth and Parental Stress and Resilience. Front Psychol 2021; 12:647645. [PMID: 34335364 PMCID: PMC8320170 DOI: 10.3389/fpsyg.2021.647645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
The COVID-19 health crisis has led to a dramatic change in dynamics and habits of families, which may be a factor involved in the development and maintenance of problems and difficulties in children. The present study is a cross-sectional study that aims to describe and analyze the relationship between the difficulties in psychological adjustment and the change of habits of the infant-juvenile population as perceived by their parents and their stress and resilience during the total confinement of the first wave of the COVID-19 pandemic in Spain, as well as analyzing the course of the changes and the relationships between weeks 3 to 6, that is, the score of different participants in each week of the confinement. The sample is comprised of 883 parents of children and adolescents between 3 and 18 years of age. Children’s psychological adjustment, children’s habits, parental stress, and parental resilience were assessed by parents. The results show that parents perceive a change in the habits and psychological difficulties in their children. At the same time, our results describe parents with a high level of stress and resilience, with differences depending on the children’s ages. The time of confinement accentuates the perception of parents about the psychological difficulties of their children and parental stress, as well as a decrease in resilience. These difficulties are reduced when the parent has resilience competencies. These results show that the resilience of parents mediate the relationship between parental stress and psychological problems of their children. These results shows that COVID-19 lockdown had a considerable effect on families, both on children and parents. Some practical implications based on results are provided.
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Affiliation(s)
| | - Juan M Flujas-Contreras
- Department of Psychology, University of Almería, Almería, Spain.,Health Research Center (CEINSA/UAL), University of Almería, Almería, Spain
| | | | - Inmaculada Gómez-Becerra
- Department of Psychology, University of Almería, Almería, Spain.,Health Research Center (CEINSA/UAL), University of Almería, Almería, Spain
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Lynskey SJ, Ling F, Greenberg AM, Penny-Dimri JC, Sutherland AG. The influence of patient resilience and health status on satisfaction after total hip and knee arthroplasty. Surgeon 2021; 19:8-14. [DOI: 10.1016/j.surge.2020.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 12/27/2022]
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Morse JM, Kent-Marvick J, Barry LA, Harvey J, Okang EN, Rudd EA, Wang CY, Williams MR. Developing the Resilience Framework for Nursing and Healthcare. Glob Qual Nurs Res 2021; 8:23333936211005475. [PMID: 33869667 PMCID: PMC8020405 DOI: 10.1177/23333936211005475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022] Open
Abstract
Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.
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Affiliation(s)
- Janice M. Morse
- University of Utah, Salt Lake City, USA
- University of Alberta
| | | | - Lisa A. Barry
- University of Utah, Salt Lake City, USA
- Intermountain Healthcare, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Jennifer Harvey
- University of Utah, Salt Lake City, USA
- Alaska Native Medical Center, Anchorage, Alaska
| | | | | | | | - Marcia R. Williams
- University of Utah, Salt Lake City, USA
- Cedarville University, Ohio
- Kettering Health Network, Cedarville, Ohio
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Geraerds AJLM, Richardson A, Haagsma J, Derrett S, Polinder S. A systematic review of studies measuring health-related quality of life of general injury populations: update 2010-2018. Health Qual Life Outcomes 2020; 18:160. [PMID: 32471430 PMCID: PMC7260776 DOI: 10.1186/s12955-020-01412-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background Studies examining the impact of injury on health-related quality of life (HRQL) over time are necessary to understand the short- and long-term consequences of injury for population health. The aim of this systematic review was to provide an evidence update on studies that have measured HRQL over time in general injury populations using a generic (general) health state measure. Methods Studies conducted between 2010 and 2018 that assessed HRQL at more than one time point among general injury populations were eligible for inclusion. Two reviewers independently extracted information from each study on design, HRQL measure used, method of HRQL measure administration, timing of assessment(s), predictive variables, ability to detect change, and findings. Quality appraisals of each study were also completed by two reviewers using items from the RTI Item Bank on Risk of Bias and Precision of Observational Studies and the Guidelines for the Conduction of Follow-up Studies Measuring Injury-Related Disability. Results Twenty-nine studies (44 articles) that met the inclusion criteria were identified. HRQL was measured using 14 different generic measures; the SF-36, SF-12, and EQ-5D were used most frequently. A varying number of follow-up assessments were undertaken, ranging from one to five. Follow-up often occurred 12 months post-injury. Fewer studies (n = 11) examined outcomes two or more years post-injury, and only one to 10 years post-injury. While most studies documented improvements in HRQL over time since the injury event, study populations had not returned to pre-injury status or reached general population norm HRQL values at post-injury follow-ups. Conclusions Since 2010 there has been a substantial increase in the number of studies evaluating the HRQL of general injury populations. However, significant variability in study design continues to impede quantification of the impact of injury on population health over time. Variation between studies is particularly evident with respect to timing and number of follow-up assessments, and selection of instruments to evaluate HRQL.
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Affiliation(s)
- A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
| | - Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
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Abstract
Resilience, the capacity to recover from a setback or adversity, is a concept that has received considerable recent attention. An individual's resilience predicts their life trajectory following stressful events and this has increasingly been shown in a wide variety of applications. Our understanding of the degree to which we can modify our resilience, and the optimal means to do so, remains in its infancy. The US military has embraced extensive efforts to quantify and build resilience in service members in an effort to preserve the fighting force. We specifically look at the understanding of resilience as it relates to the athletes in terms of competition and return from injury. This article explores the concept of resilience, the efforts to build resilience, lessons learned from the military and applications of the resilience concept to surgical and trauma patients.
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Carr BW, Severance SE, Bell TM, Zarzaur BL. Perceived loss of social support after non-neurologic injury negatively impacts recovery. J Trauma Acute Care Surg 2020; 88:113-120. [PMID: 31856020 PMCID: PMC6945784 DOI: 10.1097/ta.0000000000002515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic injury is not only physically devastating, but also psychologically isolating, potentially leading to poor quality of life, depression and posttraumatic stress disorder (PTSD). Perceived social support (PSS) is associated with better outcomes in some populations. What is not known is if changes in PSS influence long-term outcomes following nonneurologic injury. We hypothesized that a single drop in PSS during recovery would be associated with worse quality of life. METHODS This is a post hoc analysis of a prospectively collected database that included patients 18 years or older admitted to a Level I trauma center with Injury Severity Score (ISS) of 10 or higher, and no traumatic brain or spinal cord injury. Demographic and injury data were collected at the initial hospital admission. Screening for depression, PTSD, and Medical Outcomes Study Short Form 36 Mental Composite Score (MCS) were obtained at the initial hospitalization, 1, 2, 4, and 12 months postinjury. The Multidimensional Scale of Perceived Social Support (MSPSS) was obtained at similar time points. Patients with high MSPSS (>5) at baseline were included and grouped by those that ever reported a score ≤5 (DROP), and those that remained high (STABLE). Outcomes were determined at 4 and 12 months. RESULTS Four hundred eleven patients were included with 96 meeting DROP criteria at 4 months, and 97 at 1 years. There were no differences in sex, race, or injury mechanism. The DROP patients were more likely to be single (p = 0.012 at 4 months, p = 0.0006 at 1 year) and unemployed (p = 0.016 at 4 months, and p = 0.026 at 1 year) compared with STABLE patients. At 4 months and 1 year, DROP patients were more likely to have PTSD, depression, and a lower MCS (p = 0.0006, p < 0.0001). CONCLUSION Patients who have a drop in PSS during the first year of recovery have significantly higher odds of poor psychological outcomes. Identifying these socially frail patients provides an opportunity for intervention to positively influence an otherwise poor quality of life. LEVEL OF EVIDENCE Therapeutic, Prognostic and Epidemiological, Level III.
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Affiliation(s)
- Bryan W Carr
- From the Indiana University School of Medicine (B.W.C., S.E.S., T.M.B.), Indianapolis, Indiana; and University of Wisconsin School of Medicine and Public Health (B.L.Z.), Madison, Wisconsin
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11
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Kortlever JTP, Keulen MHF, Teunis T, Ring D, Driscoll MD, Reichel LM, Vagner GA. Does resiliency mediate the association of psychological adaptability with disability and pain in patients with an upper extremity injury or illness? J Psychosom Res 2019; 117:1-9. [PMID: 30665589 DOI: 10.1016/j.jpsychores.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Symptom intensity and magnitude of limitations are highly variable for a given nociception and pathophysiology. As psychological determinants are of great influence to physical wellbeing, we assessed the influence of the protective factor measured and labelled as resilience in upper extremity illness. METHODS One hundred and six patients completed a survey of demographics, the Brief Resilience Scale (BRS), the Psychological Adaptation Scale (PAS), an 11-point ordinal measure of pain intensity, and the PROMIS Physical Function (PROMIS PF) Computer Adaptive Test (CAT). Measures of pain intensity and PROMIS PF were repeated 3 months later. We created mediation models using structural equation modeling (SEM) to assess the mediation effect of BRS on the association of PAS and other confounding variables with disability and pain at initial assessment and 3 months later. RESULTS Resiliency does not mediate the association of psychological adaptability with physical limitations and pain intensity at baseline (P = .89 and .82 respectively) or 3 months after enrollment (P = .65 and .72 respectively). CONCLUSIONS Positive and protective factors promote beneficial resilience mechanisms that strengthen coping responses to pain and disability. In future studies we should either include more patients to improve power and provide more information about the health benefits of resilience or focus more on mood and self-efficacy on symptoms and limitations in patients with musculoskeletal illness. LEVEL OF EVIDENCE Prospective, longitudinal cohort study; Level II.
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Affiliation(s)
- Joost T P Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Mark H F Keulen
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Teun Teunis
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht; Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Matt D Driscoll
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Lee M Reichel
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Gregg A Vagner
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
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12
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Herrera-Escobar JP, Al Rafai SS, Seshadri AJ, Weed C, Apoj M, Harlow A, Brasel K, Kasotakis G, Kaafarani HMA, Velmahos G, Salim A, Haider AH, Nehra D. A multicenter study of post-traumatic stress disorder after injury: Mechanism matters more than injury severity. Surgery 2018; 164:1246-1250. [PMID: 30170820 DOI: 10.1016/j.surg.2018.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/03/2018] [Accepted: 07/18/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic injury is strongly associated with long-term mental health disorders, but the risk factors for developing these disorders are poorly understood. We report on a multi-institutional collaboration to collect long-term patient-centered outcomes after trauma, including screening for post-traumatic stress disorder. The objective of this study is to determine the prevalence of and risk factors for the development of post-traumatic stress disorder after traumatic injury. METHODS Adult trauma patients (aged 18-64) with moderate to severe injuries (Injury Severity Score ≥ 9) admitted to 3 level I trauma centers were screened between 6 and 12 months after injury for post-traumatic stress disorder. Patients were divided by mechanism: fall, road traffic injury, and intentional injury. Multiple logistic regression models were used to determine the association between baseline patient and injury-related characteristics and the development of post-traumatic stress disorder for the overall cohort and by mechanism of injury. RESULTS A total of 450 patients completed the screen. Overall 32% screened positive for post-traumatic stress disorder, but this differed significantly by mechanism, with the lowest being after a fall (25%) and highest after intentional injury (60%). Injury severity was not associated with post-traumatic stress disorder for any group, but lower educational level was associated with post-traumatic stress disorder within all the groups. Only 21% of patients who screened positive for post-traumatic stress disorder were receiving treatment at the time of the survey. CONCLUSION Post-traumatic stress disorder is common after traumatic injury, and the prevalence varies significantly by injury mechanism but is not associated with injury severity. Only a small proportion of patients who screen positive for post-traumatic stress disorder are currently receiving treatment.
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Affiliation(s)
- Juan P Herrera-Escobar
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Syeda S Al Rafai
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Anupamaa J Seshadri
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Christina Weed
- Department of Surgery, Virginia Mason Medical Center, Seattle, WA
| | - Michel Apoj
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Alyssa Harlow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA
| | - Karen Brasel
- Department of Surgery, Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - George Kasotakis
- Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA
| | - Haytham M A Kaafarani
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - George Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali Salim
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H Chan School of Public Health, Boston, MA; Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Deepika Nehra
- Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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