The impact of psychosocial variables on initial presentation and surgical outcome for ulnar-sided wrist pathology: a cohort study with 1-year follow-up

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

Introduction

Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom.

Methods

An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers.

Results

Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain's syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD.

Conclusion

Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD.

COVID-19 vaccination in people living with HIV and AIDS (PLWHA) in China: A cross-sectional study

COVID-19 appears to put people living with HIV and AIDS (PLWHA) at a higher risk of catastrophic consequences and mortality. However, investigations on the hesitancy and vaccination behavior of PLWHA in China were lacking compared to the general population. From January 2022 to March 2022, we conducted a multi-center cross-sectional survey of PLWHA in China. Logistic regression models were used to examine factors associated to vaccine hesitancy and COVID-19 vaccine uptake. Among 1424 participants, 108 participants (7.6%) were hesitant to be vaccinated while 1258 (88.3%) had already received at least one dose of the COVID-19 vaccine. Higher COVID-19 vaccine hesitancy was associated with older age, a lower academic level, chronic disease, lower CD4+ T cell counts, severe anxiety and despair, and high perception of illness. Lower education level, lower CD4+ T cell counts, and significant anxiety and depression were all associated with a lower vaccination rate. When compared to vaccinated participants, those who were not hesitant but nevertheless unvaccinated had a higher presence of chronic disease and lower CD4+ T cell count. Tailored interventions (e.g. targeted education programs) based on these linked characteristics were required to alleviate concerns for PLWHA in promoting COVID-19 vaccination rates, particularly for PLWHA with lower education levels, lower CD4+ T cell counts, and severe anxiety and depression.

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score-matched Comparative Study

BACKGROUND

A small proportion of patients treated for a hand or wrist condition are also involved in a personal injury claim that may or may not be related to the reason for seeking treatment. There are already indications that patients involved in a personal injury claim have more severe symptoms preoperatively and worse surgical outcomes. However, for nonsurgical treatment, it is unknown whether involvement in a personal injury claim affects treatment outcomes. Similarly, it is unknown whether treatment invasiveness affects the association between involvement in a personal injury claim and the outcomes of nonsurgical treatment. Finally, most studies did not take preoperative differences into account.

QUESTIONS/PURPOSES

(1) Do patients with a claim have more pain during loading, less function, and longer time to return to work after nonsurgical treatment than matched patients without a personal injury claim? (2) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after minor surgery than matched patients without a personal injury claim? (3) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after major surgery than matched patients without a personal injury claim?

METHODS

We used data from a longitudinally maintained database of patients treated for hand or wrist disorders in the Netherlands between December 2012 and May 2020. During the study period, 35,749 patients for whom involvement in a personal injury claim was known were treated nonsurgically or surgically for hand or wrist disorders. All patients were invited to complete the VAS (scores range from 0 to 100) for pain and hand function before treatment and at follow-up. We excluded patients who did not complete the VAS on pain and hand function before treatment and those who received a rare treatment, which we defined as fewer than 20 occurrences in our dataset, resulting in 29,101 patients who were eligible for evaluation in this study. Employed patients (66% [19,134 of 29,101]) were also asked to complete a questionnaire regarding return to work. We distinguished among nonsurgical treatment (follow-up at 3 months), minor surgery (such as trigger finger release, with follow-up of 3 months), and major surgery (such as trapeziectomy, with follow-up at 12 months). The mean age was 53 ± 15 years, 64% (18,695 of 29,101) were women, and 2% (651 of 29,101) of all patients were involved in a personal injury claim. For each outcome and treatment type, patients with a personal injury claim were matched to similar patients without a personal injury claim using 1:2 propensity score matching to account for differences in patient characteristics and baseline pain and hand function. For nonsurgical treatment VAS analysis, there were 115 personal injury claim patients and 230 matched control patients, and for return to work analysis, there were 83 claim and 166 control patients. For minor surgery VAS analysis, there were 172 personal injury claim patients and 344 matched control patients, and for return to work analysis, there were 108 claim and 216 control patients. For major surgery VAS analysis, there were 129 personal injury claim patients and 258 matched control patients, and for return to work analysis, there were 117 claim and 234 control patients.

RESULTS

For patients treated nonsurgically, those with a claim had more pain during load at 3 months than matched patients without a personal injury claim (49 ± 30 versus 39 ± 30, adjusted mean difference 9 [95% confidence interval (CI) 2 to 15]; p = 0.008), but there was no difference in hand function (61 ± 27 versus 66 ± 28, adjusted mean difference -5 [95% CI -11 to 1]; p = 0.11). Each week, patients with a personal injury claim had a 39% lower probability of returning to work than patients without a claim (HR 0.61 [95% CI 0.45 to 0.84]; p = 0.002). For patients with an injury claim at 3 months after minor surgery, there was more pain (44 ± 30 versus 34 ± 29, adjusted mean difference 10 [95% CI 5 to 15]; p < 0.001), lower function (60 ± 28 versus 69 ± 28, adjusted mean difference -9 [95% CI -14 to -4]; p = 0.001), and 32% lower probability of returning to work each week (HR 0.68 [95% CI 0.52 to 0.89]; p = 0.005). For patients with an injury claim at 1 year after major surgery, there was more pain (36 ± 29 versus 27 ± 27, adjusted mean difference 9 [95% CI 4 to 15]; p = 0.002), worse hand function (66 ± 28 versus 76 ± 26, adjusted mean difference -9 [95% CI -15 to -4]; p = 0.001), and a 45% lower probability of returning to work each week (HR 0.55 [95% CI 0.42 to 0.73]; p < 0.001).

CONCLUSION

Personal injury claim involvement was associated with more posttreatment pain and a longer time to return to work for patients treated for hand or wrist disorders, regardless of treatment invasiveness. Patients with a personal injury claim who underwent surgery also rated their postoperative hand function as worse than similar patients who did not have a claim. Depending on treatment invasiveness, only 42% to 55% of the personal injury claim patients experienced a clinically relevant improvement in pain. We recommend that clinicians extensively discuss the expected treatment outcomes and the low probability of a clinically relevant improvement in pain with their personal injury claim patients and that they broach the possibility of postponing treatment.

LEVEL OF EVIDENCE

Level III, therapeutic study.