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Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am 2024; 49:729-735. [PMID: 37498270 PMCID: PMC10818022 DOI: 10.1016/j.jhsa.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Psychosocial factors influence pain and recovery after extremity trauma and may be targets for early intervention. This may be of particular interest for patients with adult traumatic brachial plexus injury (BPI), given the broad and devastating impact of the injury. We hypothesized that there would be an association between depressive symptoms, anxiety, and pain interference with preoperative disability and expectations for improvement after BPI surgery. METHODS We enrolled 34 patients into a prospective multicenter cohort study for those undergoing surgery for adult traumatic BPI. Before surgery, participants completed Patient-Reported Outcome Measurement Information System scales for pain interference, anxiety, and depressive symptoms, and a validated BPI-specific measure of disability and expected improvement. We performed Pearson correlation analysis between pain interference, anxiety symptoms, and depressive symptoms with (A) disability and (B) expected improvement. We created separate linear regression models for (A) disability and (B) expected improvement including adjustment for severity of plexus injury, age, sex, and race. RESULTS Among 34 patients, there was a moderate, statistically significant, correlation between preoperative depressive symptoms and higher disability. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. There was no association between severity of plexus injury and disability. Depressive symptoms also were moderately, but significantly, correlated with higher expected improvement. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. CONCLUSIONS Depressive symptoms are associated with greater disability and higher expected improvement before BPI surgery. Screening for depressive symptoms can help BPI teams identify patients who would benefit from early referral to mental health specialists and tailor appropriate expectations counseling for functional recovery. We did not find an association between severity of BPI and patient-reported disability, suggesting either that the scale may lack validity or that the sample is biased. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mihir J Desai
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Dukan R, Gerosa T, Masmejean EH. Daily Life Impact of Brachial Plexus Reconstruction in Adults: 10 Years Follow-Up. J Hand Surg Am 2023; 48:1167.e1-1167.e7. [PMID: 35641388 DOI: 10.1016/j.jhsa.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 02/06/2022] [Accepted: 03/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Reconstructive surgery of brachial plexus injury in adults remains a challenge. Short- and midterm follow-up results have been described in terms of impairments, such as muscle strength grading. However, psychologic management has been shown to be a major contributor in long-term results. A new, specific brachial plexus injury scale, including functional and psychologic components, was described. Objectives of this study were: (1) to assess functional long-term brachial plexus reconstruction outcomes; and (2) to validate the Mancuso scale at 10 years of follow-up. METHODS Twenty patients with at least 10 years of follow-up were included in the study. Four patients had C5-C6 palsy and 16 had a C5-T1 injury. Shoulder abduction and elbow flexion were assessed with Medical Research Council grades. Shoulder function was evaluated with a Constant score. The 36-item short-form survey (SF36) was used to assess quality of life, and the quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was used for patient reports of disability. The Mancuso scale was assessed and correlated to the different scores used. RESULTS At the last follow-up, the Medical Research Council grade was at least grade 3 in 10 cases (50%) of shoulder abduction and in 12 cases (60%) of elbow flexion. The Constant score was 31.4 (SD, 15.1). The SF36 score was 67.5 (SD, 4.25) and the QuickDASH was 50 (SD, 15.9). We found a correlation between the symptom score (Mancuso score) and the different quality-of-life scores (QuickDASH: coefficient, 0.491; SF36: coefficient, -0.565; limitations score: coefficient, 0.445). CONCLUSIONS This study reported results from the Mancuso scale at a minimum of 10 years of follow-up of reconstructive surgery for brachial plexus injury in adults. Correlations between this composite scale and the SF36 and QuickDASH scores suggest construct validity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ruben Dukan
- Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France.
| | - Thibault Gerosa
- Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emmanuel Henri Masmejean
- Hand, Upper Limb, and Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), Paris, France; University of Paris-Medical School, Paris, France; Clinique Blomet (Research Unit), Paris, France
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de Moraes AA, Dantas DDS, Chagas ACDS, de Melo PH, de Oliveira DA. Linking assessment instruments for brachial plexus injury to the international classification of functioning, disability and health. J Hand Ther 2023; 36:885-894. [PMID: 34247880 DOI: 10.1016/j.jht.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Brachial plexus injuries (BPI) affect not only body structure and function, but also several aspects of individual's well-being. Considering the crescent need for assessing such patients through a biopsychosocial perspective, linking meaningful concepts of BPI instruments to the International Classification of Functioning, Disability and Health (ICF) provides a useful overview of how the ICF components are contemplated on the current measurements available. PURPOSE To identify patient-reported outcome measures (PROMs) specifically designed for BPI assessment and link the content with the ICF. STUDY DESIGN Content Analysis through ICF linking. METHODS The study was conducted in two steps: the first one encompassed a literature review to identify questionnaires specifically designed for assessing patients with BPI, where two PROMs were eligible: the Brachial Assessment Tool (BrAT) and the Impact of Brachial Plexus Injury Questionnaire (IBPIQ); in the second phase, the items of such instruments were linked to the ICF by two independent reviewers, in accordance to the methodology proposed by Cieza et al. RESULTS 54 different significant concepts were identified from the 74 questionnaire items and linked to 49 distinct ICF categories. The categories were mostly related to the activities and participation component (56.9%, n = 29), followed by body functions (27.45%, n = 14), body structures (9.8%, n = 5) and environmental factors component (1.96%, n = 1). CONCLUSION The questionnaires developed for adults with BPI were BrAT and IBPIQ. Although both instruments presented with a diverse coverage of ICF components, their content had a major focus on activities and participation domain and poorly or did not addressed environmental factors. Thus, other instruments could be considered in a complementary way for clinical assessment.
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Wolff AL, Mancuso CA, Lee SK, Wolfe SW. Development and Validation of a Survey to Measure Patients' Expectations of Wrist Arthritis Surgery. J Wrist Surg 2023; 12:337-344. [PMID: 37564617 PMCID: PMC10411062 DOI: 10.1055/s-0042-1759524] [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: 07/08/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
Background The purpose of this study was to develop and test a patient-derived expectations survey for wrist arthritis surgery. We hypothesized that preoperative patient expectations are higher in people with greater functional impairment and that postoperative fulfilment of patient expectations correlates with functional improvement. Methods The study was conducted in four phases. Development (n = 22) Preoperatively, patients were asked open-ended questions regarding expectations of surgery. A draft survey was then assembled. Reliability (n = 35) The survey was administered twice preoperatively. Concordance was measured with weighted kappa values and intraclass correlations (ICC). Validity (n = 58) Validity was assessed by comparing responses from the Expectations Survey to the patient-rated wrist evaluation (PRWE). Responsiveness (n = 18) Responsiveness was calculated by comparing the proportion of expectations fulfilled to PRWE scores 1-year postoperatively. Results Development Twenty-two distinct items representing the most frequent responses were utilized from the draft survey items of 1,244 expectations volunteered. Reliability Patients had high preoperative expectations of surgery (mean = 76.8); 30% had scores ≥90. Test-retest reliability was high (Cronbach α coefficients = 0.91, 0.93, ICC = 0.86). Endorsement of items = 66 to 100%; and weighted kappa values = 0.39 to 0.96. Validity Patients with greater preoperative expectations (≥63) had more pain, worse function, and worse PRWE scores than those with lower expectations. Responsiveness The proportion of fulfilled expectations was high (mean 0.80, median 0.79), and greater fulfillment (proportion > 0.80, n = 8) was associated with better postoperative PRWE scores. Conclusion The patient-derived expectations survey is reliable, valid, responsive, and addresses a spectrum of expectations for patients undergoing surgery for wrist arthritis. Clinical relevance Understanding patient expectations can contribute to customized care given the range of surgical choices for the arthritic wrist.
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Affiliation(s)
- Aviva L Wolff
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, New York
| | - Carol A Mancuso
- Department of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Steve K Lee
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Lieberdorfer A, Shivakumar N, Stonner MM, Brogan DM, Ray WZ, Mackinnon SE, Dy CJ. Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for Radial Nerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, and Treatment Experiences. J Bone Joint Surg Am 2023; 105:600-606. [PMID: 36795855 DOI: 10.2106/jbjs.22.01201] [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] [Indexed: 02/18/2023]
Abstract
BACKGROUND After a radial nerve injury, patients must weigh a complicated set of advantages and disadvantages to observation or surgery. We conducted semistructured interviews to characterize the decision-making process that these patients undertake. METHODS We recruited participants who were treated with expectant management (nonoperatively), received only a tendon transfer, or received a nerve transfer. Participants completed a semistructured interview that was transcribed and coded to identify recurring themes, to describe the influence of qualitative findings on treatment decision-making. RESULTS We interviewed 15 participants (5 expectant management, 5 tendon transfer only, and 5 nerve transfer). Participants' primary concerns were returning to work, hand appearance, regaining motion, resuming activities of daily living, and enjoying hobbies. Delayed diagnosis and/or insurance coverage led 3 participants to change treatment from nerve transfer to isolated tendon transfer. Interactions with providers early in diagnosis and treatment had strong effects on how members of the care team were perceived. The hand therapist was the primary person who shaped expectations, provided encouragement, and prompted referral to the treating surgeon. Participants valued debate among the care team members regarding treatment, provided that medical terminology was explained. CONCLUSIONS This study highlights the importance of initial, collaborative care in setting expectations for patients with radial nerve injuries. Many participants named returning to work and hand appearance as primary concerns. Hand therapists were the primary source of support and information during recovery. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Adam Lieberdorfer
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nirmala Shivakumar
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Macyn M Stonner
- Milliken Hand Therapy Center, Washington University School of Medicine, St. Louis, Missouri
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Doi K, Sem SH, Hattori Y, Sakamoto S, Hayashi K. Psychometric Evaluation of the Disabilities of the Arm, Shoulder and Hand Outcome Questionnaire for Brachial Plexus Injury Using Rasch Analysis. J Hand Surg Asian Pac Vol 2022; 27:285-293. [PMID: 35404203 DOI: 10.1142/s2424835522500230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used patient-reported outcome measure (PROM) for assessment of upper extremity disability assessment. However, DASH is a multidimensional measurement with different difficulty levels and ratio apportionment of the items categorised by ordinal scale. This has caused a misinterpretation of the total disability scores. We created a modified DASH adapted to the Rasch model. The aim of this study is to compare the functional recovery and quality of life (QOL) improvement and to assess the validity of the original DASH and modified DASH between C56/C567, C5-8 and total types of brachial plexus injury (BPI) following surgical reconstruction. Methods: A total of 183 BPI patients who underwent reconstructive surgery were evaluated for functional recovery using the range of motion and power of the affected limb, and improvement in QOL with DASH. The collected data were analysed using Rasch measurement theory to detect the misfit items. The original and modified DASH were compared under the three different types of BPI after item reduction by removing the misfit items. Results: There were significant differences in functional recovery between three types of palsy. However, PROM using DASH score with or without misfit items (12 items) did not show any significant differences. Conclusions: DASH is not suitable for comparison of upper extremity disabilities even after being corrected mathematically due to the inclusion of items from many different domains unequally. Therefore, each item of the function (with or without compensation of the uninjured hand), pain and impact to the patients should be evaluated separately. Level of Evidence: Level IV (Prognostic).
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Affiliation(s)
- Kazuteru Doi
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Sei Haw Sem
- Department of Orthopaedics, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Yasunori Hattori
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Sotetsu Sakamoto
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
| | - Kota Hayashi
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori, Yamaguchi, Japan
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Pulos N, van den Berg C, Kaufman KR, Shin AY. Application of myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: a retrospective clinical study. Prosthet Orthot Int 2021; 45:521-525. [PMID: 34772869 DOI: 10.1097/pxr.0000000000000046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Adult traumatic brachial plexus injuries (BPIs) can result in severe impairment following penetrating wounds, falls, and motor vehicle accidents or other high-energy trauma. OBJECTIVE Quantify functional outcomes of adult patients with a BPI using a myoelectric orthosis to restore elbow flexion. STUDY DESIGN Retrospective review. METHODS A clinic specializing in the BPI treatment at a large academic medical center tested nineteen adult patients with BPI. These patients had failed to achieve antigravity elbow flexion following their injury and observation or surgical reconstruction. They were provided a myoelectric elbow orthosis (MEO) if they had detectable electromyography signals. RESULTS There was significant improvement in strength and significant reductions in function and pain when using an MEO. Following initiation of the MEO, 12 of the 19 patients had clinical improvements in muscle strength, 15 patients showed improvement in their DASH, and 13 patients reported improvements in their Visual Analog Scale. CONCLUSION The use of an MEO improves elbow flexion strength, increases function, and reduces pain in the majority of patients with BPI and inadequate elbow flexion following observation or surgical reconstruction.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Dy CJ, Brogan DM, Rolf L, Ray WZ, Wolfe SW, James AS. A qualitative study of life satisfaction after surgery for adult traumatic brachial plexus injury. Bone Jt Open 2021; 2:9-15. [PMID: 33537671 PMCID: PMC7842160 DOI: 10.1302/2633-1462.21.bjo-2020-0175.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aims Brachial plexus injury (BPI) is an often devastating injury that affects patients physically and emotionally. The vast majority of the published literature is based on surgeon-graded assessment of motor outcomes, but the patient experience after BPI is not well understood. Our aim was to better understand overall life satisfaction after BPI, with the goal of identifying areas that can be addressed in future delivery of care. Methods We conducted semi-structured interviews with 15 BPI patients after initial nerve reconstruction. The interview guide was focused on the patient’s experience after BPI, beginning with the injury itself and extending beyond surgical reconstruction. Inductive and deductive thematic analysis was used according to standard qualitative methodology to better understand overall life satisfaction after BPI, contributors to life satisfaction, and opportunities for improvement. Results Among the 15 patients interviewed, the following themes emerged: 1) happiness and life satisfaction were noted despite limitations in physical function; 2) quality of social support influences life satisfaction during recovery from BPI; and 3) social participation and having a sense of purpose impact life satisfaction during recovery from BPI. Conclusion How patients perceive their BPI treatment and recovery varies widely, and is not directly linked to their self-reported functional outcome. Patients with stronger social circles and activities that give them a sense of fulfillment were more likely to be satisfied with their current status. Evaluating a patient’s social network, goals, and potential supportive adaptations early in the treatment timeline through coordinated multidisciplinary care may improve overall satisfaction during recovery from BPI. Cite this article: Bone Joint Open 2020;2(1):9–15.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Liz Rolf
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Dy CJ, Brogan DM, Rolf L, Ray WZ, Wolfe SW, James AS. Variability in Surgeon Approaches to Emotional Recovery and Expectation Setting After Adult Traumatic Brachial Plexus Injury. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 3:30-35. [PMID: 33537663 PMCID: PMC7853659 DOI: 10.1016/j.jhsg.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Increasing emphasis has been placed on multidisciplinary care for patients with traumatic brachial plexus injury (BPI), and there has been a growing appreciation for the impact of psychological and emotional components of recovery. Because surgeons are typically charged with leading the recovery phase of BPI, our objective was to build a greater understanding of surgeons’ perspectives on the care of BPI patients and potential areas for improvement in care delivery. Methods We conducted semistructured qualitative interviews with 14 surgeons with expertise in BPI reconstruction. The interview guide contained questions regarding the surgeons’ practice and care team structure, their attitudes and approaches to psychological and emotional aspects of recovery, and their preferences for setting patient expectations. We used inductive thematic analysis to identify themes. Results There was a high degree of variability in how surgeons addressed emotional and psychological aspects of recovery. Whereas some surgeons embraced the practice of addressing these components of care, others felt strongly that BPI surgeons should remain focused on technical aspects of care. Several participants described the emotional toll that caring for BPI patients can have on surgeons and how this concern has affected their approach to care. Surgeons also recognized the importance of setting preoperative expectations. There was an emphasis on setting low expectations in an attempt to minimize the risk for dissatisfaction. Surgeons described the challenges in effectively counseling patients about a condition that is prone to substantial injury heterogeneity and variability in functional outcomes. Conclusions Our results demonstrate wide variability in how surgeons address emotional, psychological, and social barriers to recovery for BPI patients. Clinical relevance Best practices for BPI care are difficult to establish because of the relative heterogeneity of neurologic injury, the unpredictable impact and recovery of the patient, and the substantial variability in physician approach to the care of these patients.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Liz Rolf
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St Louis, MO
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Aimee S James
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
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Smolev ET, Rolf L, Zhu E, Buday SK, Brody M, Brogan DM, Dy CJ. "Pill Pushers and CBD Oil"-A Thematic Analysis of Social Media Interactions About Pain After Traumatic Brachial Plexus Injury. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 3:36-40. [PMID: 33537664 PMCID: PMC7853657 DOI: 10.1016/j.jhsg.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose Brachial plexus injury (BPI) patients use on-line groups for peer support, often seeking information from Facebook groups devoted to BPI. We hypothesized that a qualitative thematic analysis of posts from BPI Facebook groups would demonstrate the areas in which patients were seeking information regarding treatment of BPI and reveal potential sources of misinformation that patients may encounter. Methods We identified the 2 most popular public Facebook groups for BPI by searching key words “traumatic brachial plexus injury.” We selected posts containing comments regarding BPI from November 1, 2018 through October 31, 2019. We excluded posts regarding brachial plexus birth injury. We used iterative inductive and deductive thematic analysis for the qualitative data to identify recurring topics, knowledge gaps, potential roles of patient educational interventions, and patient interaction dynamics. Two investigators independently coded all posts and resolved discrepancies by discussion. Results A total of 7,694 posts from 2 leading Facebook support groups were analyzed. Three themes emerged: (1) When discussing pain management, there was recurring anti-opioid sentiment. Posters who currently used opioids or supported those who did discussed perceived effects of the opioid epidemic on their treatment, on their relationships with care providers, and on availability of the medication. (2) Posters advocated for alternatives to traditional approaches to pain management, referring to prescribers as pill pushers and touting cannabinoids as a safer and more effective replacement. (3) There was strong anti-gabapentinoid sentiment owing to reported adverse effects and a perceived lack of efficacy, despite its role as a first-line treatment for neuropathic pain. Conclusions Examination of posts from Facebook support groups for BPI revealed recurring themes, questions, misinformation, and opinions from posters with regard to treatment of neuropathic pain. These findings can help clinicians who care for BPI patients identify areas to focus on during patient encounters to address neuropathic pain that commonly occurs with BPI. Clinical relevance Brachial plexus injury surgeons should be aware of information, misinformation, and opinions on social media, because these may influence patient–surgeon interactions.
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Affiliation(s)
- Emma T Smolev
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Liz Rolf
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
| | - Eric Zhu
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Sarah K Buday
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO
| | - Madison Brody
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St Louis, MO.,Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO
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11
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Mancuso CA, Lee SK, Dy CJ, Landers ZA, Model Z, Wolfe SW. Response to: Comments on "Compensation by the Uninjured Arm After Brachial Plexus Injury". Hand (N Y) 2018; 13:123. [PMID: 29291657 PMCID: PMC5755872 DOI: 10.1177/1558944717743602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carol A. Mancuso
- Hospital for Special Surgery, New York, USA,Weill Cornell Medical College, New York, USA,Carol A. Mancuso, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Steve K. Lee
- Hospital for Special Surgery, New York, USA,Weill Cornell Medical College, New York, USA
| | | | | | - Zina Model
- Hospital for Special Surgery, New York, USA
| | - Scott W. Wolfe
- Hospital for Special Surgery, New York, USA,Weill Cornell Medical College, New York, USA
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