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Núñez-Cortés R, Cruz-Montecinos C, Torres-Castro R, Tapia C, Püschel TA, Pérez-Alenda S. Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2021; 103:1615-1627. [PMID: 34861234 DOI: 10.1016/j.apmr.2021.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR). DATA SOURCES Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021. STUDY SELECTION Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR. DATA EXTRACTION Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Rodrigo Torres-Castro
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| | - Claudio Tapia
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom; Primate Models for Behavioural Evolution Lab, Institute of Cognitive and Evolutionary Anthropology, School of Anthropology, University of Oxford, Oxford, United Kingdom
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain.
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McLaren S, Sims L, Cheng Y, Khan R, Sauder D. The Effects of Patient Resilience and Catastrophizing on Carpal Tunnel Surgical Outcomes. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:322-328. [PMID: 35415583 PMCID: PMC8991772 DOI: 10.1016/j.jhsg.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Outcomes following carpal tunnel release (CTR) are generally favorable. When patient satisfaction or symptom resolution is not as expected, understanding what factors contribute to that outcome could allow for strategies targeted at improving results. Our purpose was to determine if measurable mental health factors, specifically resilience and pain catastrophization, correlate with patients’ postoperative outcomes following CTR. Methods A prospective cohort study was performed. Ninety-four patients were recruited to take part in the study. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale, and the Brief Resilience Scale. A single surgeon, or his resident under supervision, performed an open CTR under local anesthetic. Our primary outcome measure was a repeat BCTQ at 6 months. Pearson correlation coefficients and univariate analyses were performed to assess the correlation between Pain Catastrophizing Scale and Brief Resilience Scale scores and final BCTQ scores. Results Forty-three and 63 participants completed the BCTQ at 3 and 6 months, respectively. This was 10% below the number needed to achieve appropriate power. Among those that responded, all participants showed improvement in their symptoms (P = .001). There was no correlation between patients’ Pain Catastrophizing Scale or Brief Resilience Scale scores and 6-month BCTQ scores or the amount of improvement in the BCTQ at final follow-up. Conclusions Most participants improved following CTR. Patients’ self-assessed resilience, and the degree of pain catastrophization did no correlate with the amount of improvement patients had after surgery. Type of study/level of evidence Prognostic II.
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Otlans PT, Szukics PF, Bryan ST, Tjoumakaris FP, Freedman KB. Resilience in the Orthopaedic Patient. J Bone Joint Surg Am 2021; 103:549-559. [PMID: 33470590 DOI: 10.2106/jbjs.20.00676] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Resilience is a dynamic psychological construct that refers to the ability to adapt and improve when facing adversity or other stressors. ➤ Recent investigations in various orthopaedic subspecialties have demonstrated that resilience may contribute to favorable mental health and physical function after a surgical procedure. ➤ More research, using well-designed prospective studies, is necessary to better define the role that resilience and other factors play in the health and outcomes of patients with orthopaedic conditions. ➤ Orthopaedic surgeons can consider incorporating resilience assessments into their practices to aid in identifying patients who will do well with a surgical procedure and those who may benefit from specialized therapy to optimize their health and function.
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Affiliation(s)
- Peters T Otlans
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Patrick F Szukics
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey
| | - Sean T Bryan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fotios P Tjoumakaris
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Mosegaard SB, Stilling M, Hansen TB. Pain Catastrophizing Scale as a predictor of low postoperative satisfaction after hand surgery. J Orthop 2020; 21:245-248. [PMID: 32280161 DOI: 10.1016/j.jor.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022] Open
Abstract
Background Psychological measures are used increasingly in outcome studies. The Pain Catastrophizing Scale is a 13-item questionnaire used to measure coping skills and negative feelings of pain. In the existing literature it is suggested that the Pain Catastrophizing Scale could be associated with the outcome following surgery. The aim of this study was to examine the effect of catastrophic thinking on postoperative satisfaction after treatment for hand conditions where pain is not the predominant symptom (Dupuytren's disease, trigger finger and wrist ganglia), and further to estimate cut-points on the Pain Catastrophizing Scale. Methods A total of 413 patients (53% females) with a mean age of 59 years were included in this one-year prospective follow-up study. The patients were diagnosed with either Dupuytren's disease (N = 133), trigger finger (N = 365), or wrist ganglia (N = 147). Preoperative data included disability (Disability of the Arm, Shoulder and Hand questionnaire (DASH)), quality of life (EuroQol-5D (EQ-5D)), and pain catastrophizing (Pain Catastrophizing Scale (PCS)). One year postoperative, data on DASH score, EQ-5D, and patient satisfaction were collected. We used a classification tree to define the most important cut-points, which could classify patients as low-risk or high-risk of low postoperative satisfaction. These cut-points and the 75th percentile cut-point was then used in logistic regression models with postoperative satisfaction as outcome variable. Results The median DASH score improved from 13.5 to 2.6 (p < 0.01), and the median EQ-5D score improved from 0.82 to 1.00, and 90.3% of patients were satisfied or very satisfied with the surgery.Using the 75th percentile (≤12) we did not find a predictive effect of PCS. However, when using the two cut-points from the classification tree (≤27.5 & ≤2.9) all tested models were statistically significant with odds ratios for risk of low satisfaction ranging from 2.81 to 6.44. Only the model using PCS ≤27.5 adjusted for both demographics and disability was insignificant. Conclusion This study suggests that PCS can be a valuable tool in predicting postoperative satisfaction in hand conditions where pain is not the predominant symptom, and that ≤27.5 and ≤ 2.9 are the optimal cut-point on the preoperative PCS.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Torben Bæk Hansen
- University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Mosegaard SB, Stilling M, Hansen TB. Higher preoperative pain catastrophizing increases the risk of low patient reported satisfaction after carpal tunnel release: a prospective study. BMC Musculoskelet Disord 2020; 21:42. [PMID: 31954407 PMCID: PMC6969973 DOI: 10.1186/s12891-020-3058-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background Carpal tunnel syndrome is a common upper-limb nerve compression disease. Carpal tunnel syndrome can lead to several symptoms such as tingling or numbness, pain in the hand or wrist, and reduced grip strength. Based on demographic characteristics, patient reported outcome measures, and with special attention to pain catastrophizing, the purpose of this study was to identify risk factors for low patient-reported satisfaction following surgical treatment of idiopathic carpal tunnel syndrome. Methods A total of 417 hands from 417 patients (64. 5% females) with a mean age of 58. 0 years were included in this 1-year prospective follow-up study. We collected preoperative data on disability using the Disability of the Arm, Shoulder and Hand questionnaire (DASH), quality of life using the EuroQol-5D (EQ-5D), pain catastrophizing using the Pain Catastrophizing Scale (PCS) and distal motor latency. Data on DASH score, EQ-5D, and patient satisfaction was collected 12 months postoperatively. Wilcoxon matched-pairs signed-rank test was used to test for difference in preoperative and postoperative DASH and EQ-5D score. Risk factors for low postoperative patient reported satisfaction was examined using stepwise multiple logistic regression analysis. Results We found a general improvement in patients’ DASH scores (12.29 [95% CI: 10.65–13.90], p < 0.001) and EQ-5D (0.14 [95% CI: 0.13–0.16], p < 0.001) from preoperative to 12 months postoperative. In the fully adjusted multiple regression analysis we found a statistically significant effect of preoperative PCS on patient reported satisfaction with OR = 1.05 (p = 0.022), for a one unit increase in preoperative PCS. There was no statistically significant predictive effect of preoperative EQ-5D (p = 0.869), DASH (p = 0.076), distal motor latency (p = 0.067), age (p = 0.505) or gender (p = 0.222). Conclusions Patients improved in both DASH and EQ-5D from preoperative to 12 months postoperative. Higher preoperative PCS seems to have a negative effect on postoperative patient reported satisfaction after carpal tunnel release.
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Affiliation(s)
- Sebastian Breddam Mosegaard
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark.
| | - Maiken Stilling
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Lægårdvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, 8000, Aarhus, Denmark
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Ingram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, Value, and Patient Satisfaction in Carpal Tunnel Surgery. Orthop Clin North Am 2018; 49:503-507. [PMID: 30224011 DOI: 10.1016/j.ocl.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The cost of carpal tunnel release (CTR) surgery can be decreased and patient satisfaction increased by a few relatively simple changes. Although cost estimates vary in the literature, most investigators agree that open CTR costs less than endoscopic CTR, and the clinic procedure room or ambulatory surgery center is cheaper than the ambulatory surgery center, which is less than the hospital. Patient satisfaction can be increased by making office visits more patient-centered and improving the quality of dialogue between the surgeon and patient.
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Affiliation(s)
- Joseph Ingram
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Benjamin M Mauck
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Norfleet B Thompson
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - James H Calandruccio
- Campbell Clinic-University of Tennessee, Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Affiliation(s)
- Seok-Woo Hong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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