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Steiner Q, Watson AM, Mosiman SJ, Spiker AM. Association Between Symptoms of Anxiety and Depression, Hip Pathology, and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Am J Sports Med 2024; 52:1728-1734. [PMID: 38771945 DOI: 10.1177/03635465241252821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. PURPOSE To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patient records from a single surgeon's hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. RESULTS A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P > .05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: -0.59 ± 0.07, P < .0001; depression: -0.64 ± 0.08, P < .0001), iHOT-12 scores (anxiety: -0.72 ± 0.07, P < .0001; depression: -0.72 ± 0.08, P < .0001), HOS-SS scores (anxiety: -0.68 ± 0.09, P < .0001; depression: -0.57 ± 0.10, P < .0001), and HOS-ADL scores (anxiety: -0.43 ± 0.05, P < .0001; depression: -0.43 ± 0.06, P < .0001). CONCLUSION Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy.
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Affiliation(s)
- Quinn Steiner
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew M Watson
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samuel J Mosiman
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Daher M, Alsoof D, Balmaceno-Criss M, Kuharski MJ, Criddle SL, Diebo BG, Daniels AH. Preoperative Resilience and Improvement in Patient-Reported Outcomes After Lumbar Spinal Fusion. World Neurosurg 2024; 186:e531-e538. [PMID: 38583559 DOI: 10.1016/j.wneu.2024.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND It is incompletely understood how preoperative resilience affects 1-year postoperative outcomes after lumbar spinal fusion. METHODS Patients undergoing open lumbar spinal fusion at a single-center institution were identified between November 2019 and September 2022. Preoperative resilience was assessed using the Brief Resilience Scale. Demographic data at baseline including age, gender, comorbidities, and body mass index (BMI) were extracted. Patient-reported outcome measures including Oswestry Disability Index, PROMIS (Patient-Reported Outcomes Measurement Information System) Global Physical Health, PROMIS Global Mental Health (GMH), and EuroQol5 scores were collected before the surgery and at 3 months and 1 year postoperatively. Bivariate correlation was conducted between Brief Resilience Scale scores and outcome measures at 3 months and 1 year postoperatively. RESULTS Ninety-three patients had baseline and 1 year outcome data. Compared with patients with high resilience, patients in the low-resilience group had a higher percentage of females (69.4% vs. 43.9%; P = 0.02), a higher BMI (32.7 vs. 30.1; P = 0.03), and lower preoperative Global Physical Health (35.8 vs. 38.9; P = 0.045), GMH (42.2 vs. 49.2; P < 0.001), and EuroQol scores (0.56 vs. 0.61; P = 0.01). At 3 months postoperatively, resilience was moderately correlated with GMH (r = 0.39) and EuroQol (r = 0.32). Similarly, at 1 year postoperatively, resilience was moderately correlated with GMH (r = 0.33) and EuroQol (r = 0.34). Comparable results were seen in multivariable regression analysis controlling for age, gender, number of levels fused, BMI, Charlson Comorbidity Index, procedure, anxiety/depression, and complications. CONCLUSIONS Low preoperative resilience can negatively affect patient-reported outcomes 1 year after lumbar spinal fusion. Resiliency is a potentially modifiable risk factor, and surgeons should consider targeted interventions for at-risk patient groups.
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Affiliation(s)
- Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael J Kuharski
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sarah L Criddle
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Romere C, Ramtin S, Nunziato C, Ring D, Laverty D, Hill A. Is Pain in the Uninjured Leg Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Lower Extremity Injury? Clin Orthop Relat Res 2023; 481:2368-2376. [PMID: 37249315 PMCID: PMC10642885 DOI: 10.1097/corr.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patients recovering from lower extremity injuries often interpret discomfort associated with increased use of the uninjured leg as a potential indication of harm. If expressed concerns regarding contralateral leg pain are associated with unhelpful thinking regarding symptoms, they can signal orthopaedic surgeons to gently reorient these thoughts to help improve comfort and capability during recovery. QUESTIONS/PURPOSES We asked: (1) Among people recovering from isolated traumatic lower extremity injury, is pain intensity in the uninjured leg associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Are pain intensity in the injured leg, magnitude of capability, and accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms? METHODS Between February 2020 and February 2022, we enrolled 139 patients presenting for an initial evaluation or return visit for any traumatic lower extremity injury at the offices of one of three musculoskeletal specialists. Patients had the option to decline filling out our surveys, but because of the cross-sectional design, required fields on the electronic survey tools, and monitored completion, there were few declines and few incomplete surveys. The median age of participants was 41 years (IQR 32 to 58), and 48% (67 of 139) were women. Fifty percent (70 of 139) injured their right leg. Sixty-five percent (91 of 139) had operative treatment of their fracture. Patients completed measures of pain intensity in the uninjured leg, pain intensity in the injured leg, lower extremity-specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis sought factors independently associated with pain intensity in the uninjured leg, pain intensity in the injured leg, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. RESULTS Greater pain intensity in the uninjured leg (regression coefficient [RC] 0.09 [95% CI 0.02 to 0.16]; p < 0.01) was moderately associated with more unhelpful thinking regarding symptoms. This indicates that for every one-unit increase in unhelpful thinking regarding symptoms on the 17-point scale we used to measure pain catastrophizing, pain intensity in the uninjured leg increases by 0.94 points on the 11-point scale that we used to measure pain intensity, holding all other independent variables constant. Greater pain intensity in the injured leg (RC 0.18 [95% CI 0.08 to 0.27]; p < 0.01) was modestly associated with more unhelpful thinking regarding symptoms. Greater pain accommodation (RC -0.25 [95% CI -0.38 to -0.12]; p < 0.01) was modestly associated with less unhelpful thinking regarding symptoms. Greater magnitude of capability was not independently associated with less unhelpful thinking regarding symptoms. CONCLUSION A patient's report of concerns regarding pain in the uninjured limb (such as, "I'm overcompensating for the pain in my other leg") can be considered an indicator of unhelpful thinking regarding symptoms. Orthopaedic surgeons can use such reports to recognize unhelpful thinking and begin guiding patients toward healthier thoughts and behaviors. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Chase Romere
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Carl Nunziato
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Laverty
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Austin Hill
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Pierson SR, Ngoue M, Lam R, Rajagopalan D, Ring D, Ramtin S. When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy? Clin Orthop Relat Res 2023; 481:1771-1780. [PMID: 36853843 PMCID: PMC10427050 DOI: 10.1097/corr.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/05/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Patient use of verbal and nonverbal communication to signal what is most important to them can be considered empathetic opportunities. Orthopaedic surgeons may have mixed feelings toward empathetic opportunities, on one hand wanting the patient to know that they care, and on the other hand fearing offense, prolonged visit duration, or discussions for which they feel ill prepared. Evidence that action about empathetic opportunities does not harm the patient's experience or appreciably prolong the visit could increase the use of these communication tactics with potential for improved experience and outcomes of care. QUESTIONS/PURPOSES Using transcripts from musculoskeletal specialty care visits in prior studies, we asked: (1) Are there factors, including clinician attentiveness to empathetic opportunities, associated with patient perception of clinician empathy? (2) Are there factors associated with the number of patient-initiated empathetic opportunities? (3) Are there factors associated with clinician acknowledgment of empathetic opportunities? (4) Are there factors associated with the frequency with which clinicians elicited empathetic opportunities? METHODS This study was a retrospective, secondary analysis of transcripts from prior studies of audio and video recordings of patient visits with musculoskeletal specialists. Three trained observers identified empathetic opportunities in 80% (209 of 261) of transcripts of adult patient musculoskeletal specialty care visits, with any uncertainties or disagreements resolved by discussion and a final decision by the senior author. Patient statements considered consistent with empathetic opportunities included relation of emotion, expression of worries or concerns, description of loss of valued activities or loss of important roles or identities, relation of a troubling psychologic or social event, and elaboration on daily life. Clinician-initiated empathetic opportunities were considered clinician inquiries about these factors. Clinician acknowledgment of empathetic opportunities included encouragement, affirmation or reassurance, or supportive statements. Participants completed post-visit surveys of perceived clinician empathy, symptoms of depression, and health anxiety. Factors associated with perceived clinician empathy, number of empathetic opportunities, clinician responses to these opportunities, and the frequency with which clinicians elicited empathetic opportunities were sought in bivariate and multivariable analyses. RESULTS After controlling for potentially confounding variables such as working status and pain self-efficacy scores in the multivariable analysis, no factors were associated with patient perception of clinician empathy, including attentiveness to empathetic opportunities. Patient-initiated empathetic opportunities were modestly associated with longer visit duration (correlation coefficient 0.037 [95% confidence interval 0.023 to 0.050]; p < 0.001). Clinician acknowledgment of empathetic opportunities was modestly associated with longer visit duration (correlation coefficient 0.06 [95% CI 0.03 to 0.09]; p < 0.001). Clinician-initiated empathetic opportunities were modestly associated with younger patient age (correlation coefficient -0.025 [95% CI -0.037 to -0.014]; p < 0.001) and strongly associated with one specific interviewing clinician as well as other clinicians (correlation coefficient -1.3 [95% CI -2.2 to -0.42]; p = 0.004 and -0.53 [95% CI -0.95 to -0.12]; p = 0.01). CONCLUSION Musculoskeletal specialists can respond to empathic opportunities without harming efficiency, throughput, or patient experience. CLINICAL RELEVANCE Given the evidence that patients prioritize feeling heard and understood, and evidence that a trusting patient-clinician relationship is protective and healthful, the results of this study can motivate specialists to train and practice effective communication tactics.
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Affiliation(s)
- S. Ryan Pierson
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Marielle Ngoue
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ryan Lam
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Dayal Rajagopalan
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - David Ring
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sina Ramtin
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
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Romere C, Ramtin S, Nunziato C, Ring D, Laverty D, Hill A. Is Pain in the Uninjured Arm Associated With Unhelpful Thoughts and Distress Regarding Symptoms During Recovery From Upper-Extremity Injury? J Hand Surg Am 2023:S0363-5023(23)00170-3. [PMID: 37204359 DOI: 10.1016/j.jhsa.2023.03.019] [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: 08/26/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE During recovery from upper-extremity injury, patients sometimes express concerns regarding pain associated with increased use of the uninjured limb. Concerns about discomfort associated with increased use may represent a manifestation of unhelpful thoughts such as catastrophic thinking or kinesiophobia. We asked the following questions: (1) Among people recovering from an isolated unilateral upper-extremity injury, is pain intensity in the uninjured arm associated with unhelpful thoughts and feelings of distress regarding symptoms, accounting for other factors? (2) Is pain intensity in the injured extremity, magnitude of capability, or accommodation of pain associated with unhelpful thoughts and feelings of distress regarding symptoms? METHODS In this cross-sectional study of new or returning patients presenting to a musculoskeletal specialist for care for an upper-extremity injury, the patients completed scales that were used to measure the following: pain intensity in the uninjured arm, pain intensity in the injured arm, upper-extremity-specific magnitude of capability, symptoms of depression, symptoms of health anxiety, catastrophic thinking, and accommodation of pain. Multivariable analysis was used to evaluate factors associated with pain intensity in the uninjured arm, pain intensity in the injured arm, magnitude of capability, and pain accommodation, controlling for other demographic and injury-related factors. RESULTS Greater pain intensity in both uninjured and injured arms was independently associated with greater unhelpful thinking regarding symptoms. A greater magnitude of capability and pain accommodation were independently associated with less unhelpful thinking regarding symptoms. CONCLUSIONS Given that greater pain intensity in the uninjured upper extremity is associated with greater unhelpful thinking, clinicians can be attuned to patient concerns about contralateral pain. Clinicians can facilitate recovery from upper-extremity injury by evaluating the uninjured limb as well as identifying and ameliorating unhelpful thinking regarding symptoms. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Chase Romere
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Carl Nunziato
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
| | - David Laverty
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Austin Hill
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
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Mo KC, Gupta A, Movsik J, Covarrubius O, Greenberg M, Riley LH, Kebaish KM, Neuman BJ, Skolasky RL. Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery. Spine J 2023; 23:723-730. [PMID: 37100496 PMCID: PMC10154031 DOI: 10.1016/j.spinee.2022.12.015] [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: 06/03/2022] [Revised: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND CONTEXT Pain self-efficacy, or the belief that one can carry out activities despite pain, has been shown to be associated with back and neck pain severity. However, the literature correlating psychosocial factors to opioid use, barriers to proper opioid use, and Patient-Reported Outcome Measurement Information System (PROMIS) scores is sparse. PURPOSE The primary aim of this study was to determine whether pain self-efficacy is associated with daily opioid use in patients presenting for spine surgery. The secondary aim was to determine whether there exists a threshold self-efficacy score that is predictive of daily preoperative opioid use and subsequently to correlate this threshold score with opioid beliefs, disability, resilience, patient activation, and PROMIS scores. PATIENT SAMPLE Five hundred seventy-eight elective spine surgery patients (286 females; mean age of 55 years) from a single institution were included in this study. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. OUTCOME MEASURES PROMIS scores, daily opioid use, opioid beliefs, disability, patient activation, resilience. METHODS Elective spine surgery patients at a single institution completed questionnaires preoperatively. Pain self-efficacy was measured by the Pain Self-Efficacy Questionnaire (PSEQ). Threshold linear regression with Bayesian information criteria was utilized to identify the optimal threshold associated with daily opioid use. Multivariable analysis controlled for age, sex, education, income, and Oswestry Disability Index (ODI) and PROMIS-29, version 2 scores. RESULTS Of 578 patients, 100 (17.3%) reported daily opioid use. Threshold regression identified a PSEQ cutoff score of <22 as predictive of daily opioid use. On multivariable logistic regression, patients with a PSEQ score <22 had two times greater odds of being daily opioid users than those with a score ≥22. Further, PSEQ <22 was associated with lower patient activation; increased leg and back pain; higher ODI; higher PROMIS pain, fatigue, depression, and sleep scores; and lower PROMIS physical function and social satisfaction scores (p<.05 for all). CONCLUSIONS In patients presenting for elective spine surgery, a PSEQ score of <22 is associated with twice the odds of reporting daily opioid use. Further, this threshold is associated with greater pain, disability, fatigue, and depression. A PSEQ score <22 can identify patients at high risk for daily opioid use and can guide targeted rehabilitation to optimize postoperative quality of life.
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Affiliation(s)
- Kevin C Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan Movsik
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Oscar Covarrubius
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Marc Greenberg
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Lindsey C, Dornan GJ, McKelvey K. Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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McConaghy K, Rullan P, Murray T, Molloy R, Heinberg LJ, Piuzzi NS. Team Approach: Management of Mental Health in Orthopaedic Patients. JBJS Rev 2023; 11:01874474-202302000-00003. [PMID: 36763707 DOI: 10.2106/jbjs.rvw.22.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
» Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. » The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. » Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.
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Affiliation(s)
- Kara McConaghy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Pedro Rullan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor Murray
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Grant-Freemantle M, Moore J, McBrien D, Condon F, Harmon D. The role of perceived patient injustice on pain related and functional outcomes in orthopaedic patients; a systematic review. J Orthop 2023; 36:19-23. [PMID: 36582546 PMCID: PMC9793222 DOI: 10.1016/j.jor.2022.12.006] [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: 03/27/2022] [Revised: 10/15/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Higher levels of perceived patient injustice has been associated with higher levels of pain and poor functional outcomes in patients with chronic musculoskeletal pain. We wanted to investigate if there was any evidence of this association in patients who underwent orthopaedic surgery. Materials and methods A systematic search of the literature was performed independently by two researchers on the electronic databases of MEDLINE, EMBASE, Google Scholar, Web of Science, and the Cochrane Database of Systematic Reviews and data extracted in accordance with PRISMA guidelines for systematic reviews. Outcomes of interest were pain, pain intensity, pain interference, opiate use, disability, physical function, return to work, quality of life, depression, anxiety, post-traumatic stress, social functioning and quality of life. Results Five studies were identified for qualitative analysis involving elective and trauma orthopaedic patients. All studies identified a positive correlation between higher levels of perceived injustice and depression, pain intensity and interference as well as reduced function and higher levels of disability. Conclusions Higher levels of perceived patient injustice is associated with worse pain and functional outcomes in patients who undergo orthopaedic surgery in the traumatic and elective setting. Further research is warranted to further elucidate this association and identify potential therapeutic interventions.
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Affiliation(s)
- M.C. Grant-Freemantle
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - J. Moore
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - D. McBrien
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - F. Condon
- Department of Trauma and Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
- University of Limerick, Limerick, Ireland
| | - D.C. Harmon
- Department of Anaesthesia and Pain Medicine, University Hospital Limerick, Limerick, Ireland
- University of Limerick, Limerick, Ireland
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Vranceanu AM, Bakhshaie J, Reichman M, Ring D. A Call for Interdisciplinary Collaboration to Promote Musculoskeletal Health: The Creation of the International Musculoskeletal Mental and Social Health Consortium (I-MESH). J Clin Psychol Med Settings 2022; 29:709-715. [PMID: 34605997 DOI: 10.1007/s10880-021-09827-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/24/2022]
Abstract
Despite increasing recognition of psychosocial factors in musculoskeletal conditions, its impact on reducing the global toll of musculoskeletal symptoms has been only incremental. It is time to bring together clinicians and researchers with heterogeneous backgrounds, unified by a commitment to reduce the global impact of musculoskeletal illness by addressing mental and social health factors. In 2020, we initiated the International Musculoskeletal Mental and Social Health Consortium. Our current key priority areas are: (1) Develop best practices for uniform terminology, (2) Understand barriers to mental and social health care for musculoskeletal conditions, (3) Develop clinical and research resources. The purpose of this paper is to render a call to interdisciplinary collaboration on the psychological aspects of musculoskeletal health. We believe this international interdisciplinary collaboration is pivotal to the advancement of the biopsychosocial model of musculoskeletal care and has the potential to improve the health of individuals with musculoskeletal conditions globally.
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Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA.
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Shan Y, Liu X, Chen W, Chen R, Jin L, Sun H, Lu H. Predictors of psychological resilience trajectories in patients with knee arthroplasty: A longitudinal study. J Adv Nurs 2022; 79:1926-1938. [PMID: 35975332 DOI: 10.1111/jan.15421] [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: 05/11/2022] [Revised: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
AIMS To identify the different classes of total knee arthroplasty patients according to the heterogenous trajectories of psychological resilience and investigate the predictors for different patterns of resilience. DESIGN A prospective cohort study. METHODS A total of 210 patients with total knee arthroplasty from March to December 2021 were included. Baseline assessment (T0) data were collected before surgery and included demographic, biological (clinical characteristics), psychological (psychological resilience, self-efficacy, psychological distress, hope, medical coping mode) and social (social support) factors. Resilience measurements were repeated at 3 days after surgery (T1), the date of discharge (T2), and 1 month (T3) and 3 months (T4) after discharge. Latent growth mixture modelling was employed to define different resilience trajectories. Predictors of class membership were identified using multinomial logistic regression. RESULTS Data from 198 patients were analysed. Three latent classes were identified with similar patterns in different intercepts, showing a significant decrease in resilience from admission (T0) to 3 days after surgery (T1) followed by an increase from T1 to T4. The three trajectories of psychological resilience were named the stable-resilience class (65.66%), high-resilience class (17.68%), and low-resilience class (16.66%). Multinomial logistic regression showed that compared with the stable-resilience class, the high-resilience class was predicted by having a higher level of hope, having higher education, living in urban areas and having more children, while the low-resilience class was predicted by having lower levels of self-efficacy and hope, living in semirural areas, and having more children. CONCLUSIONS The three trajectories indicated that surgery was the major stressor influencing patients' psychological resilience and that patients in the low-resilience class needed to be intervened. IMPACT Predictors of patients in different classes provide evidence for the identification of vulnerable populations and lay a foundation for future research contributing to the development of targeted interventions for improving patients' psychological resilience. No patient or public contribution but the time points of investigation were decided based on our interviews with 12 total knee arthroplasty patients.
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Affiliation(s)
- Yawei Shan
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyu Liu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weijia Chen
- Department of Nursing, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ru Chen
- Department of Nursing, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lijuan Jin
- Department of Nursing, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huimin Sun
- Department of Nursing, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haiying Lu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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12
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Kortlever JTP, Vargas S, Reichel LM, Ring D, Vagner GA. Randomized Controlled Trial Comparing Nylon and Chromic Gut Sutures After Minor Hand Surgery. J Hand Surg Am 2022; 47:795.e1-795.e13. [PMID: 34509310 DOI: 10.1016/j.jhsa.2021.07.026] [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: 08/23/2020] [Revised: 05/23/2021] [Accepted: 07/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to compare overall satisfaction with treatment and satisfaction with initial wound healing after closure of office hand and upper extremity surgery wounds using polyamide compared to Chromic gut sutures. METHODS We compared 62 patients randomized to polyamide suture closure of an office hand and upper extremity incision (mostly carpal tunnel release and trigger finger release) to 50 patients closed with Chromic gut suture. Patients rated overall treatment satisfaction, satisfaction with initial healing, pain intensity, and upper extremity-specific activity tolerance. RESULTS Accounting for potential confounding in multivariable linear and logistic regression analysis, we found the following: (1) overall satisfaction with care was unrelated to suture type; (2) satisfaction with initial wound healing and appearance was lower among people with no other comorbidities, but unrelated to suture type; (3) there were no factors independently associated with pain intensity; and (4) excisional biopsy was associated with greater activity tolerance. CONCLUSIONS Our findings suggests that Chromic sutures are a viable alternative to polyamide sutures after office hand surgery, provided that the care team anticipates and develops strategies for concerns that may arise if the sutures take an extended period to fall off. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Joost T P Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Sara Vargas
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Lee M Reichel
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
| | - Gregg A Vagner
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
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13
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Ryan C, Miner H, Ramachandran S, Ring D, Fatehi A. General Anxiety Is Associated with Problematic Initial Recovery After Carpal Tunnel Release. Clin Orthop Relat Res 2022; 480:1576-1581. [PMID: 35023866 PMCID: PMC9278949 DOI: 10.1097/corr.0000000000002115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Carpal tunnel release can stop the progression of idiopathic median neuropathy at the wrist (carpal tunnel syndrome). Intermittent symptoms tend to resolve after surgery, but loss of sensibility can be permanent. Both pathophysiology (severe neuropathy) and mental health (symptoms of despair or worry) contribute to problematic recovery after carpal tunnel release, but their relative associations are unclear. QUESTION/PURPOSE Is problematic initial recovery after carpal tunnel release associated with psychologic distress rather than with disease severity? METHODS We retrospectively studied 156 patients who underwent in-office carpal tunnel release between November 2017 and February 2020, and we recorded their symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD]) and depression (Patient Health Questionnaire), signs of severe median neuropathy (loss of sensibility, thenar muscle atrophy, and palmar abduction weakness), and problematic recovery. The initial recovery (first 2 weeks) was categorized as problematic if the patient was upset about persistent numbness, experienced unsettling postoperative pain, developed hand stiffness, or experienced wound issues-all of which are routinely recorded in the medical record by the treating surgeon along with signs of severe median neuropathy. Twenty-four percent (38 of 156) of patients had a problematic initial recovery characterized by distress regarding persistent numbness (16% [25 of 156]), unsettling pain (8% [12 of 156]), hand stiffness (5% [8 of 156]), or wound issues (1% [2 of 156]); 6% (9 of 156) of patients had more than one issue. Associations between problematic initial recovery and age, gender, symptoms of anxiety and depression, disease severity, specific exam findings, and insurance were evaluated using t-tests, Mann-Whitney tests, and chi-square tests, with the plan to perform logistic regression if at least two variables had an association with p < 0.10. RESULTS The only factor associated with problematic initial recovery was greater symptoms of anxiety (median GAD score 1.5 [interquartile range 0 to 7.8] for problematic initial recovery compared with a median score of 0 [IQR 0 to 2] for nonproblematic recovery; p = 0.04), so we did not perform a logistic regression. Physical examination findings consistent with severe median neuropathy were not associated with problematic initial recovery. CONCLUSION The finding that problematic initial recovery after carpal tunnel release was related to symptoms of anxiety and not to the severity of median neuropathy highlights the need to study the ability of efforts to ameliorate anxiety symptoms before carpal tunnel release as an effective intervention to reduce unplanned visits and additional tests, therapy, and repeat surgery, while improving patient-reported outcomes and experience. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Claire Ryan
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Harrison Miner
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Shyam Ramachandran
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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14
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Mental health status, not resilience, influences functional recovery after arthroscopic rotator cuff repairs. J Shoulder Elbow Surg 2022; 31:S117-S122. [PMID: 35288297 DOI: 10.1016/j.jse.2022.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent literature has shown the importance of patient psychosocial status in overcoming stressful events, such as surgery. Resilience, the ability to "bounce back" from adversity, has been recently correlated to outcomes following arthroscopic rotator cuff repair (RCR). Overall mental well-being has also been shown to be important because patients with clinical depression and anxiety may have worse outcomes. Substantial clinical benefit (SCB) is the threshold of outcome improvement that a patient perceives as considerable. The purpose of this study was to assess the influence of preoperative resilience, mental health status, and rotator cuff tear size on patient outcome recovery measured by the American Shoulder and Elbow Surgeons (ASES) score. METHODS Patients undergoing arthroscopic RCR performed from 2016 through 2019 at a single tertiary institution by fellowship-trained sports surgeons with a high-volume shoulder practice were included. The Brief Resilience Scale (BRS) score and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) were collected preoperatively. ASES scores were obtained preoperatively, as well as 6 and 12 months postoperatively. Patients were divided into 2 groups based on the SCB threshold of 87 for the ASES score based on validated, established literature. Rotator cuff tear size was classified as small (≤3 cm) or large (>3 cm). VR-12 MCS, BRS, and ASES scores were compared at baseline, 6 months, and 1 year using separate mixed-model analyses of variance between the tear size and SCB groups. For ASES score comparison, the VR-12 MCS was used as a covariate to account for differences in baseline mental status. RESULTS RCR was performed in 119 patients, with an average age of 61 years (standard deviation, 10 years). There were 71 male and 48 female patients. At 6 months, 43% of patients met the SCB threshold. The VR-12 MCS was significantly different between RCR patients who met the SCB threshold for the ASES score and those who did not at 6 and 12 months for large rotator cuff tears (P = .001) but not small tears (P = .07). The BRS score was not different between the tear size and SCB groups at any time point (P = .12). CONCLUSION Our results show that patients who met the SCB threshold at 6 months postoperatively after arthroscopic RCR demonstrated higher preoperative VR-12 MCS values; however, higher preoperative BRS scores were not seen in those meeting the SCB threshold. In fact, when baseline VR-12 MCS values were accounted for in patients with large rotator cuff tears, the differences in ASES scores normalized. This finding suggests that baseline mental health status, as measured by the VR-12 MCS, significantly influenced patients' functional recovery following RCR. Future research should focus on preoperative psychosocial well-being to optimize postoperative outcomes.
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15
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Bonsu JM, Feroe AG. What's Important: Public Health in Orthopaedic Surgery. J Bone Joint Surg Am 2022; 104:755-756. [PMID: 34473663 DOI: 10.2106/jbjs.21.00796] [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: 02/01/2023]
Affiliation(s)
- Janice M Bonsu
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Aliya G Feroe
- Harvard Medical School, Harvard School of Public Health, Boston, Massachusetts
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16
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Sagar I, Popok PJ, Reichman M, Lester EG, Doorley J, Bakhshaie J, Vranceanu AM. Orthopedic Providers’ Preferences for Education and Training on Psychosocial Clinical Research Initiatives: A Qualitative Investigation. J Patient Exp 2022; 9:23743735221092570. [PMID: 35450087 PMCID: PMC9016593 DOI: 10.1177/23743735221092570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Psychosocial factors (e.g., depression, anxiety) increase risk for
chronic pain, disability, and other health complications following acute
orthopedic traumatic injury. Orthopedic providers lack skills to address these
factors. Education around psychosocial factors of recovery and psychosocial
clinical and research initiatives could address this gap. The purpose of this
study was to understand orthopedic trauma providers’ preferences for the design
and distribution of educational materials to facilitate psychosocial initiative
implementation. Methods: We conducted live-video, semi-structured focus groups with outpatient
orthopedic trauma providers across three Level 1 Trauma Centers, using a hybrid
inductive-deductive approach to analyze qualitative data and extract themes and
subthemes characterizing providers’ recommendations for appropriate psychosocial
education. Results: Four themes described providers’ recommendations for receiving
educational materials: (1) provide foundational knowledge and tools about
psychosocial factors; (2) provide information regarding a psychosocial
initiative's purpose and procedures; (3) leverage educational materials to
maximize buy-in to psychosocial clinical research initiatives; and (4) deliver
information concisely, clearly, and electronically. Conclusion: Orthopedic providers recommended ways to optimize design and
dissemination of education on psychosocial care. Optimizing knowledge of
psychosocial factors and clinical and research initiatives facilitates
providers’ ability to appropriately target the often-underdressed psychosocial
component of recovery in orthopedics.
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Affiliation(s)
- Isabell Sagar
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Paula J. Popok
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ethan G. Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ana Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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17
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DiSilvestro KJ, Bond D, Alsoof D, McDonald CL, Hartnett DA, Hogan WB, Veeramani A, Daniels AH. Preoperative Resilience and Early Postoperative Outcomes following Lumbar Spinal Fusion. World Neurosurg 2022; 163:e573-e578. [PMID: 35427792 DOI: 10.1016/j.wneu.2022.04.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies identified a correlation between preoperative resilience scores and patient reported outcome measures in several surgical subspecialities. No previous studies, to our knowledge, have analyzed preoperative resilience and patient reported outcomes in lumbar spinal fusion. METHODS Patients undergoing lumbar spinal fusion completed the brief resilience scale preoperatively, in addition to measures of disability (Oswestry Disability index (ODI)), quality of life (PROMIS global physical and mental health scales and EuroQOL5], and leg and back pain (VAS) at pre- and 3-months postoperatively. The 3-month follow-up was selected due to the association with return to work. Multiple linear regression evaluated relationships between resilience and postoperative changes in outcomes measures, controlling for baseline values and body mass index, age, number of levels fused, and severity of comorbidities. RESULTS Ninety-five participants (mean age = 58 years, 56% male) completed the BRS preoperatively and outcome measures before and 3-months after lumbar fusion. On average, participants reported significant postoperative improvements on all outcome measures (p<.001). Higher preoperative resilience scores related to greater postoperative improvements in back and leg pain, global mental and physical health and EuroQol scores (p<0.05), after controlling for baseline values and other covariates. Resilience scores did not significantly correlate with postoperative changes in ODI (p>0.05). CONCLUSIONS Preoperative resilience is associated with improvement in pain, physical and mental health quality of life during the early postoperative period following lumbar spinal fusion. Additional research is needed to determine if improvements are maintained beyond this interval and whether resilience can be modified to optimize outcomes.
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Affiliation(s)
- Kevin J DiSilvestro
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Dale Bond
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Davis A Hartnett
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - William B Hogan
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ashwin Veeramani
- Division of Applied Mathematics, Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA.
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18
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Wilson CD, Welling BD, Hammonds KAP, Robin BN. Impact of patient resilience on early recovery from rotator cuff repair. Shoulder Elbow 2022; 14:222-229. [PMID: 35265189 PMCID: PMC8899317 DOI: 10.1177/17585732211003556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
AIMS We sought to evaluate early recovery from rotator cuff repair by assessing the correlation between patient resilience and postoperative shoulder pain and function, and physical and mental health. METHODS Patients scheduled to undergo arthroscopic rotator cuff repair were prospectively enrolled. Resilience was assessed using the Brief Resilience Scale (BRS), pain and function was measured by American Society of Shoulder and Elbow Surgeons (ASES) shoulder scores, and physical and mental health was measured by the Patient-Reported Outcome Measurement Information System Global Health-10 (PROMIS-10). All scores were obtained preoperatively and postoperatively at three- and six months. Spearman correlation coefficient (r) was used to assess the relationship between variables. RESULTS Ninety-eight patients ultimately underwent rotator cuff repair; 76 and 68 patients provided three- and six-month follow-up, respectively. There was no statistically significant correlation between preoperative BRS and three- and six-month ASES. However, there was a statistically significant correlation between preoperative BRS and three-month PROMIS-10 (r = 0.3763, p = 0.009) and concurrent BRS and PROMIS-10 at three months (r = 0.5657, p = 0.0025) and six months (r = 0.5308, p = 0.0025). DISCUSSION Resilience appears to be more predictive of global physical and mental health than shoulder pain and function in early recovery from rotator cuff repair.
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Affiliation(s)
- Charlie D Wilson
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA,Charlie D Wilson, Department of Orthopaedic Surgery, Baylor Scott & White Health, 5612 Drury Ln., Temple, TX 76502, USA.
| | - Benjamin D Welling
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
| | | | - Brett N Robin
- Department of Orthopaedic Surgery, Baylor Scott & White Health, Temple, TX, USA
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19
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Reduction of Opioid Consumption After Outpatient Orthopaedic Trauma Surgeries Using a Multimodal Pain Protocol. J Am Acad Orthop Surg 2022; 30:e327-e335. [PMID: 34723860 DOI: 10.5435/jaaos-d-20-01417] [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] [Received: 01/02/2021] [Accepted: 09/22/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Because of the dearth of literature in the orthopaedic trauma population, we aimed to analyze how a multimodal pain protocol after outpatient surgery affects opioid consumption, pain scores, and patient satisfaction. METHODS This was a cohort study with a historical control at an urban level 1 trauma center. Forty consecutive outpatients were given a peripheral nerve block and a multimodal pain protocol between September 2019 and March 2020 and compared with 70 consecutive preprotocol patients who received a peripheral nerve block and hydrocodone-acetaminophen. The primary outcome was morphine milligram equivalents (MMEs) consumed. Our secondary aims were pain scores and satisfaction. RESULTS Patients in the protocol were younger (36.45 versus 45.09 years, P = 0.007), butthere was no difference in sex, body mass index, American Society of Anesthesiologists, or surgical duration. There was a 59% reduction in opioids consumed in the first 4 days after surgery (3.83 MME versus 9.29 MME, P < 0.001). At the postoperative day-14 time point, protocol patients consumed a total of 5.59 MMEs, which is 40% less than just the first 4 days of the preprotocol (P = 0.02). Protocol patients assigned a higher rating of "least pain" on postoperative day 1 (1.24 versus 0.52, P = 0.04) but had higher satisfaction scores on day 1 (9.68 versus 8.54, P < 0.001) and day 2 (9.66 versus 8.61, P < 0.001). CONCLUSION Implementation of a multimodal pain management protocol after outpatient orthopaedic trauma surgeries reduced opioid consumption by >50% in the first 4 days postoperatively. Additional studies are needed to refine the multimodal pain protocol used in this study. LEVEL OF EVIDENCE II.
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20
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Teunissen JS, van der Oest MJW, van Groeninghen DE, Feitz R, Hovius SER, Van der Heijden EPA. The impact of psychosocial variables on initial presentation and surgical outcome for ulnar-sided wrist pathology: a cohort study with 1-year follow-up. BMC Musculoskelet Disord 2022; 23:109. [PMID: 35105316 PMCID: PMC8808973 DOI: 10.1186/s12891-022-05045-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Ulnar-sided wrist pain has historically been equated to lower-back pain of wrist surgery. Little is known about the relationship between psychosocial profile and the manifestation of ulnar-sided wrist pathology and their treatment outcomes. This study aimed to determine the impact of pain catastrophising, psychological distress, illness perception, and patients' outcome expectations on patient-reported pain and hand function before and one year after surgery for ulnar-sided wrist pathology. PATIENTS AND METHODS We included patients who underwent surgical treatment for ulnar-sided wrist pathology. Before surgery, patients completed the Pain Catastrophising Scale (PCS), Patient Health Questionnaire (PHQ), Brief-Illness Perception Questionnaire (B-IPQ), and Credibility/Expectancy Questionnaire (CEQ). Pain and dysfunction were assessed before (n = 423) and one year after surgery (n = 253) using the Patient Rated Wrist/Hand Evaluation (PRWHE). Hierarchical linear regression was used to assess the relationship between psychosocial factors and the preoperative PRWHE score, postoperative PRWHE score, and change in PRWHE. RESULTS Psychosocial variables explained an additional 35% of the variance in preoperative PRWHE scores and 18% on postoperative scores. A more negative psychosocial profile was associated with higher (worse) preoperative PRWHE scores (PCS: B = 0.19, CI = [0.02-0.36]; B-IPQ Consequences: B = 3.26, CI = 2.36-4.15; and B-IPQ Identity, B = 1.88 [1.09-2.67]) and postoperative PRWHE scores (PCS: B = 0.44, CI = [0.08-0.81]) but not with the change in PRWHE after surgery. Higher treatment expectations were associated with a lower (better) postoperative PRWHE score (CEQ expectancy: B = -1.63, CI = [-2.43;-0.83]) and a larger change in PRWHE scores (B =|1.62|, CI = [|0.77; 2.47|]). CONCLUSION A more negative psychosocial profile was associated with higher pain levels and dysfunction preoperatively and postoperatively. However, these patients showed similar improvement as patients with a more feasible psychosocial profile. Therefore, patients should not be withheld from surgical treatment based on their preoperative psychosocial profile alone. Boosting treatment expectations might further improve treatment outcomes. LEVEL OF EVIDENCE III (Cohort study).
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Affiliation(s)
- J S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands.
| | - M J W van der Oest
- Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - D E van Groeninghen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - R Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - S E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Hand and Wrist Centre, Xpert Clinics, Laarderhoogtweg 12, 1101 EA, Amsterdam, The Netherlands
| | - E P A Van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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21
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Reichman M, Bakhshaie J, Grunberg VA, Doorley JD, Vranceanu AM. What Are Orthopaedic Healthcare Professionals' Attitudes Toward Addressing Patient Psychosocial Factors? A Mixed-Methods Investigation. Clin Orthop Relat Res 2022; 480:248-262. [PMID: 34779793 PMCID: PMC8747600 DOI: 10.1097/corr.0000000000002043] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Integrating psychosocial resources into orthopaedic clinics can reduce psychological distress and opioid use after injury, enhance functional outcomes, and increase patient satisfaction with care. Establishing referral pathways for connecting orthopaedic patients with psychosocial resources requires the active collaboration and buy-in of orthopaedic healthcare professionals. Designing and disseminating psychosocial training materials for orthopaedic healthcare professionals requires a nuanced understanding of orthopaedic healthcare professionals' current attitudes toward addressing psychosocial factors, including any stigma and misconceptions about mental health that exist. QUESTIONS/PURPOSES (1) What are orthopaedic healthcare professionals' attitudes toward addressing patient psychosocial factors, and how are they related? (2) How do orthopaedic healthcare professionals' beliefs, reasonings, and experiences help to explain these attitudes? (3) How do attitudes differ between physicians and nonphysician healthcare professionals? METHODS In this multisite, mixed-methods study (that is, a study collecting both quantitative and qualitative data), our team of psychology researchers conducted qualitative focus groups over secure live video with 79 orthopaedic healthcare professionals at three geographically diverse Level I trauma centers. We approached all orthopaedic healthcare professionals within the three trauma centers to participate in the study to collect as many diverse perspectives as possible. Eighty-four percent (79 of 94) of the professionals we approached participated in qualitative data collection (the group of professionals comprised 20 attending surgeons; 28 residents; 10 nurse practitioners, registered nurses, and physician assistants; 13 medical assistants; five physical therapists and social workers; and three research fellows). We also asked participants to complete self-report items that assessed their attitudes toward addressing patients' psychosocial factors (research question 1). The different attitudes identified through the quantitative measurement served as a priori defined themes within which our two independent coders organized the qualitative data and identified beliefs and experiences that explained attitudes (research question 2). We used both quantitative and qualitative data to assess differences between surgeons and residents and nonphysician healthcare professionals (research question 3). RESULTS We quantitatively identified six underlying attitudes toward addressing psychosocial factors: professional confidence, perceived resource availability, fear of offending patients, fear of negative patient reactions, blame toward patients, and professional role resistance. We observed a strong quantitative correlation between the attitudes of professional confidence and perceived resource availability, and qualitative data revealed how healthcare professionals' willingness to discuss psychosocial issues with patients is shaped by their perception of psychosocial resources available for orthopaedic patients, as well as their perception of their own skills and tools to navigate these conversations. Quantitative data suggested that surgeons and residents endorse higher blame toward patients for psychosocial factors (medium effect size; p = 0.04), which is a stigmatizing attitude that serves as a barrier to integrating psychosocial resources into orthopaedic settings. CONCLUSION The varying levels of confidence orthopaedic healthcare professionals reported with respect to the topic of discussing psychosocial factors and the misconceptions they endorse regarding psychosocial factors (such as blame toward patients) highlight the need for more specific education for orthopaedic healthcare professionals to help equip them with skills to raise and discuss psychosocial factors with patients in an empathic and destigmatizing manner. CLINICAL RELEVANCE The strong relationship observed between the attitudes of professional confidence and perceived resource availability suggests that expanding the provision of psychosocial resources in orthopaedic settings and establishing specific, efficient referral processes to connect patients with psychosocial resources will in turn increase orthopaedic healthcare professionals' confidence discussing psychosocial issues with patients.
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Affiliation(s)
- Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Victoria A. Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - James D. Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Ulack C, Suarez J, Brown L, Ring D, Wallace S, Teisberg E. What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life? J Patient Exp 2022; 9:23743735211069811. [PMID: 35024444 PMCID: PMC8744205 DOI: 10.1177/23743735211069811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This qualitative study sought to answer three questions: What is it like to live
with rotator cuff tendinopathy? What are the barriers and facilitators of a
healthy lifestyle with an aging shoulder? And, what are the outcomes that matter
most to people seeking care for rotator cuff tendinopathy? Patients diagnosed
with rotator cuff tendinopathy participated in group discussions using
semi-structured guides that focus on diagnosis, daily experiences living with
rotator cuff tendinopathy, goals, concerns, and clinical care experiences. A
hybrid of initial inductive coding of themes and subsequent deductive
consideration of these themes within the capability, comfort, and calm framework
was utilized. Themes associated with rotator cuff tendinopathy were less restful
sleep, difficulty with work and life transitions, loss of baseline abilities,
and limitation in social roles in the capability realm; physical pain, despair,
and loneliness in the comfort realm; and lack of direction or progress and
feeling uncared for in the calm realm. Barriers identified included: the sense
that rotator cuff tendinopathy is something correctable rather than
age-associated and the sense that painful activities will make the tendinopathy
worse (common misconceptions); tenuous relationships and limited trust with
clinicians; loss of hope; and a sense that care is directionless. What matters
most to a person seeking specialty care for shoulder pain are feeling that they
are getting effective care and not being dismissed; maintaining meaningful
activity and life roles; and replacing despair and frustration with hope and
progress. Anticipating these needs may facilitate the design of more effective
care models. Level of Evidence: N/A.
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Affiliation(s)
- Chris Ulack
- Value Institute for Health & Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Joel Suarez
- Cuny School of Labor and Urban Studies, The City University of New York, New York, USA
| | - Laura Brown
- Moody College of Communication, The University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Scott Wallace
- Value Institute for Health & Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Elizabeth Teisberg
- Department of Medical Education, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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American Academy of Orthopaedic Surgeons Appropriate Use Criteria: Early Screening for Psychosocial Risk and Protective Factors. J Am Acad Orthop Surg 2021; 29:e760-e765. [PMID: 34101679 DOI: 10.5435/jaaos-d-20-00810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
The Major Extremity Trauma and Rehabilitation Consortium and the American Academy of Orthopaedic Surgeons (AAOS) have developed Appropriate Use Criteria for the Early Screening for Psychosocial Risk and Protective Factors. Evidence and clinical expertise were used to develop criteria for addressing mental and social health opportunities to help people recover from musculoskeletal injuries to the extremity, spine, and pelvis. The criteria were developed by identifying observable symptoms and results of screening that suggest mental and social health challenges among patients with lower extremity trauma in clinical practice. The 32 patient scenarios and three interventions (evaluate for psychological distress, evaluate for social health opportunities, and evaluate coping and resilience strategies) were developed by the writing panel of clinicians who are specialists in mental and social health in musculoskeletal illness. Next, a separate, multidisciplinary, voting panel made up of specialists and nonspecialists rated the appropriateness of treatment for each patient scenario using a 9-point scale to designate a treatment as "appropriate" (median rating, 7 to 9), "may be appropriate" (median rating, 4 to 6), or "rarely appropriate" (median rating, 1 to 3). Notably, with a high level of agreement, the voting panel determined that interventions to address mental and social health were appropriate in all scenarios as follows: 86% were rated appropriate, 14% were rated possibly appropriate, and none were rated rarely appropriate.
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24
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Affiliation(s)
- David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin Austin, Texas
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25
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Nadarajah V, Meredith SJ, Jauregui JJ, Smuda MP, Medina S, Gilotra MN, Hasan SA, Henn RF. Preoperative opioid use in patients undergoing shoulder surgery. Shoulder Elbow 2021; 13:248-259. [PMID: 34659464 PMCID: PMC8512997 DOI: 10.1177/1758573219879689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioids are commonly used to manage pain from acute injury or chronic degenerative diseases. The objective of this study was to assess the prevalence of preoperative opioid use in patients undergoing shoulder surgery and the clinical factors associated with preoperative opioid use. METHODS This was an analytical cross-sectional study of 175 patients undergoing shoulder surgery at an urban hospital from June 2015 to June 2017. Multivariable regression models were used to determine independent associations. RESULTS Fifty-three patients reported preoperative opioid use, which was significantly associated with primary procedure performed (Current Procedural Terminology [CPT]), higher body mass index (BMI), unemployment, lower income, smoking, higher American Society of Anesthesiologists score, greater number of previous surgeries, higher comorbidity burden, and decreased expectations to exercise and do recreational activities (p < 0.05). Preoperative opioid use was independently associated with worse scores on the: Numeric Pain Scale, ASES, IPAQ, and PROMIS domains of Physical Function, Pain Interference, and Social Satisfaction (p < 0.05). CONCLUSION More than one in four patients reported preoperative opioid use. Several health measures, including worse pain, function, and social satisfaction were independently associated with preoperative opioid use. These findings suggest that orthopaedic surgeons need to identify patients using opioids preoperatively in order to effectively establish and execute a plan for pain management, which may include weaning off opioids prior to surgery, managing psychological distress, and optimizing coping strategies.Level of Evidence: III.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and
Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Shaun Medina
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
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McCurdy MA, Burt CI, Schneider MB, Zhang T, Foster MJ, Aneizi A, Gilotra MN, Hasan SA, Henn III RF. Preoperative opioid use correlates with worse patient-reported outcomes two years after elective shoulder surgery. J Orthop 2021; 25:167-172. [PMID: 34025060 PMCID: PMC8131954 DOI: 10.1016/j.jor.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Prescription opioid consumption in the United States is a well-known public health problem, however, the deleterious effect of opioids may not be fully understood. The purpose of this study was to investigate the relationship between preoperative opioid use and patient-reported outcomes two years after shoulder surgery. We hypothesized preoperative opioid use would be predictive of worse two-year patient reported outcome scores. METHODS Patients undergoing shoulder surgery at an urban institution from June 2015 to July 2017 were prospectively enrolled into our orthopaedic registry. Preoperative opioid use and its association to patient outcome scores was retrospectively analyzed through bivariate analysis. Multivariate analysis was used to control for confounding variables and to determine independent predictors of two-year outcome scores. RESULTS Preoperative opioid use was associated with significantly worse scores on all two-year patient reported outcomes, and less improvement in PROMIS Physical Function and Numeric Pain Score (NPS) Body Pain two years postoperatively. Multivariate analysis showed preoperative opioid use to be an independent predictor of worse two-year scores in PROMIS Physical Function, PROMIS Pain Interference, PROMIS Social Satisfaction, American Shoulder and Elbow Surgeons Standardized Shoulder Form and NPS Operative Site. Preoperative opioid use was not an independent predictor of change in any outcome measure. CONCLUSION Preoperative opioid use was associated with worse scores on all two-year patient reported outcomes, and after controlling for confounders, preoperative opioid use was predictive of worse scores in several two-year outcome measures. To our knowledge, this is one of the few studies investigating the impact of preoperative opioid use on postoperative outcomes after shoulder surgery.
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Affiliation(s)
- Michael A. McCurdy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B. Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J. Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S. Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn III
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Vranceanu AM, Bakhshaie J, Reichman M, Doorley J, Elwy AR, Jacobs C, Chen N, Esposito J, Laverty D, Matuszewski PE, Fatehi A, Bowers LC, Harris M, Ring D. A Live Video Program to Prevent Chronic Pain and Disability in At-Risk Adults With Acute Orthopedic Injuries (Toolkit for Optimal Recovery): Protocol for a Multisite Feasibility Study. JMIR Res Protoc 2021; 10:e28155. [PMID: 33908886 PMCID: PMC8116990 DOI: 10.2196/28155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/09/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite the pivotal role of psychosocial factors in pain and disability after orthopedic injury, there are no evidence-based preventive interventions targeting psychosocial factors in patients with acute orthopedic injuries. We developed the first mind-body intervention focused on optimizing recovery and improving pain and disability in patients with acute orthopedic injuries who exhibit high levels of catastrophic thinking about pain and/or pain anxiety (Toolkit for Optimal Recovery [TOR] after orthopedic injury). In a pilot single-site randomized controlled trial (RCT), the TOR met a priori set benchmarks for feasibility, acceptability, and satisfaction. The next step in developing TOR is to conduct a multisite feasibility RCT to set the stage for a scientifically rigorous hybrid efficacy-effectiveness trial. OBJECTIVE The objective of this study is to conduct a rigorous multisite feasibility RCT of TOR to determine whether the intervention and study methodology meet a priori set benchmarks necessary for the successful implementation of a future multisite hybrid efficacy-effectiveness trial. In this paper, we describe the study design, manualized treatments, and specific strategies used to conduct this multisite feasibility RCT investigation. METHODS This study will be conducted at 3 geographically diverse level 1 trauma centers, anonymized as sites A, B, and C. We will conduct a multisite feasibility RCT of TOR versus the minimally enhanced usual care (MEUC) control (60 patients per site; 30 per arm) targeting a priori set feasibility benchmarks. Adult patients with acute orthopedic injuries who endorse high pain catastrophizing or pain anxiety will be recruited approximately 1-2 months after injury or surgery (baseline). Participants randomized to the TOR will receive a 4-session mind-body treatment delivered via a secure live video by trained clinical psychologists. Participants randomized to the MEUC will receive an educational booklet. Primary outcomes include feasibility of recruitment, appropriateness, feasibility of data collection, acceptability of TOR (adherence to sessions), and treatment satisfaction across all sites. We will also collect data on secondary implementation outcomes, as well as pain severity, physical and emotional function, coping skills, and adverse events. Outcomes will be assessed at baseline, posttreatment, and at the 3-month follow-up. RESULTS Enrollment for the RCT is estimated to begin in June 2021. The target date of completion of the feasibility RCT is April 2024. The institutional review board approval has been obtained (January 2020). CONCLUSIONS This investigation examines the multisite feasibility of TOR administered via live videoconferencing in adult patients with acute orthopedic injuries. If feasible, the next step is a multisite, hybrid efficacy-effectiveness trial of TOR versus MEUC. Preventive psychosocial interventions can provide a new way to improve patient and provider satisfaction and decrease suffering and health care costs among patients with orthopedic injuries who are at risk for chronic pain and disability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/28155.
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Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Cale Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Neal Chen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - John Esposito
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - David Laverty
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Paul E Matuszewski
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Lucy C Bowers
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Mitchel Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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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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Cremers T, Zoulfi Khatiri M, van Maren K, Ring D, Teunis T, Fatehi A. Moderators and Mediators of Activity Intolerance Related to Pain. J Bone Joint Surg Am 2021; 103:205-212. [PMID: 33186001 DOI: 10.2106/jbjs.20.00241] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is wide variation in activity intolerance for a given musculoskeletal pathophysiology. In other words, people often experience illness beyond what one would expect given their level of pathophysiology. Mental health (i.e., cognitive bias regarding pain [e.g., worst-case thinking] and psychological distress [symptoms of anxiety and depression]) is an important and treatable correlate of pain intensity and activity intolerance that accounts for much of this variation. This study tested the degree to which psychological distress accentuates the role of cognitive bias in the relationship between pain intensity and activity intolerance. METHODS We enrolled 125 adults with musculoskeletal illness in a cross-sectional study. Participants completed measures of activity intolerance related to pain (Patient-Reported Outcomes Measurement Information System [PROMIS] Pain Interference Computer Adaptive Test [CAT]) and in general (PROMIS Physical Function CAT]), measures of psychological distress (PROMIS Depression CAT and PROMIS Anxiety CAT), a numeric rating scale (NRS) for pain intensity, measures of pain-related cognitive bias (4-question versions of the Negative Pain Thoughts Questionnaire [NPTQ-4], Pain Catastrophizing Scale [PCS-4], and Tampa Scale for Kinesiophobia [TSK-4]), and a survey of demographic variables. We assessed the relationships of these measures through mediation and moderation analyses using structural equation modeling. RESULTS Mediation analysis confirmed the large indirect relationship between pain intensity (NRS) and activity intolerance (PROMIS Pain Interference CAT and Physical Function CAT) through cognitive bias. Symptoms of depression and anxiety had an unconditional (consistent) relationship with cognitive bias (NPTQ), but there was no significant conditional effect/moderation (i.e., no increase in the magnitude of the relationship with increasing symptoms of depression and anxiety). CONCLUSIONS Psychological distress accentuates the role of cognitive bias in the relationship between pain intensity and activity intolerance. In other words, misconceptions make humans ill, more so with greater symptoms of depression or anxiety. Orthopaedic surgeons can approach their daily work with the knowledge that addressing common misconceptions and identifying psychological distress as a health improvement opportunity are important aspects of musculoskeletal care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Teun Cremers
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Michael Zoulfi Khatiri
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Koen van Maren
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - David Ring
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Teun Teunis
- Plastic Surgery Department, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Amirreza Fatehi
- Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, Texas
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Three distinct recovery patterns following primary total knee arthroplasty: dutch arthroplasty register study of 809 patients. Knee Surg Sports Traumatol Arthrosc 2021; 29:529-539. [PMID: 32274547 DOI: 10.1007/s00167-020-05969-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Total knee arthroplasty (TKA) is usually effective, although not all patients have satisfactory outcomes. This assumes distinct recovery patterns might exist. Little attention has been paid to determine which patients have worse outcomes. This study attempts to distinguish specific recovery patterns using the Oxford knee score (OKS) during the first postoperative year. The secondary aim was to explore predictors of less favourable recovery patterns. METHODS Analysis of patients in the Dutch Arthroplasty Register (LROI) with unilateral primary TKA. Data collected up to one year postoperative was used. To identify subgroups of patients based on OKS, latent class growth modeling (LCGM) was used. Moreover, multivariable multinomial logistic regression analysis was used to explore predictors of class membership. RESULTS 809 Patients completed three OKS during the first year postoperative and were included. LCGM identified 3 groups of patients; 'high risers' (most improvement during first 6-months, good 12-month scores 77%), 'gradual progressors' (continuous improvement during the first year 13%) and 'non responders' (initial improvement and subsequent deterioration to baseline score 10%). Predictors of least favourable class membership (OR, 95%CI) are EQ-5D items: VAS health score (0.83, 0.73-0.95), selfcare (2.22, 1.09-4.54) and anxiety/depression (2.45, 1.33-4.52). CONCLUSION Three recovery patterns after TKA were distinguished; 'high risers', 'gradual progressors' and 'non responders'. Worse score on EQ-5D items VAS health, selfcare, and anxiety/depression were correlated with the least favourable 'non responders' recovery pattern.
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Pearls: Effective Communication Strategies for the Biopsychosocial Paradigm of Musculoskeletal Medicine. Clin Orthop Relat Res 2020; 478:2720-2721. [PMID: 33136557 PMCID: PMC7899385 DOI: 10.1097/corr.0000000000001559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Evidence suggests that the alleviation of pain is enhancedby a strong patient-clinician relationship and attending to a patient’s social and mental health. There is a limited role for medication, opioids in particular. Orthopaedic surgeons can use comprehensive biopsychosocial strategies to help people recover and can work with colleagues who have the appropriate expertise in order to maximize pain alleviation with optimal opioid stewardship. Preparing patients for elective surgery and caring for them after unplanned injury or surgery can benefit from planned and practiced strategies based in communication science. Cite this article: Bone Joint J 2020;102-B(9):1122–1127.
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Affiliation(s)
- Laura E. Brown
- Center for Health Communication, Moody College of Communication, University of Texas at Austin, Austin, Texas, USA
| | - Amirreza Fatehi
- Department of Surgery and Operative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - David Ring
- Department of Surgery and Operative Care, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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Mismatch between expectations and physical activity outcomes at six months following hip-arthroscopy: A qualitative study. Phys Ther Sport 2020; 45:14-22. [PMID: 32570091 DOI: 10.1016/j.ptsp.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To explore factors influencing participation in physical activity for young to middle-aged patients at six months post-hip arthroscopy. DESIGN Qualitative study. SETTING Three specialist surgical centres in Australia. PARTICIPANTS Seventeen adults aged 18-50 years. MAIN OUTCOME MEASURES Individual semi-structured interviews were undertaken and transcribed verbatum. Inductive analysis of the data was undertaken, with themes identified through an iterative coding process. RESULTS Four key themes emerged from the analysis: 1) an evident mismatch between expectations and actual progress of physical activity during the first six months post-arthroscopy; 2) physical activity levels vary widely at six months post-operatively; 3) evidence of suboptimal psychological readiness to return to sport and an associated emotional toll; and 4) the influence of available support and information on post-operative physical activity. CONCLUSIONS This qualitative study has provided in-depth perspectives on recovery after hip arthroscopy. Clear opportunities exist to: 1) help patients develop realistic post-operative goals; 2) provide timely patient education and support; and 3) facilitate an effective transition to desired physical activity.
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Affiliation(s)
- David Ring
- Dell Medical School, The University of Texas at Austin, Austin, Texas
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Illness Perceptions of Patients With First Carpometacarpal Osteoarthritis, Carpal Tunnel Syndrome, Dupuytren Contracture, or Trigger Finger. J Hand Surg Am 2020; 45:455.e1-455.e8. [PMID: 31812335 DOI: 10.1016/j.jhsa.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Previous studies indicate that patients with a more negative perception of their illness tend to respond less favorably to treatment, but little is known about whether illness perceptions differ based on the type of hand or wrist conditions. Therefore, we compared illness perceptions between patients scheduled to undergo surgery for 4 illnesses in hand surgery: carpometacarpal osteoarthritis (CMC OA), Dupuytren disease, carpal tunnel syndrome (CTS), and trigger finger syndrome (TFS). We hypothesized there would be differences in illness perception between these patient groups. METHODS Before surgery, patients were asked to complete the Brief Illness Perception Questionnaire (Brief-IPQ) as part of routine outcome measurement in a specialized hand and wrist surgery clinic. The Brief-IPQ is a validated questionnaire to rapidly assess the cognitive and emotional representation of illness. Differences in illness perception between the 4 diagnostic groups, corrected for age, sex, hand dominance, and work type, were examined. Cohen D effect sizes were calculated for the between-group differences. RESULTS We included 514 patients in the analyses: 87 with CMC OA, 146 with Dupuytren disease, 129 with CTS, and 152 with TFS. On a scale ranging from 0 (most positive perception) to 80 (most negative perception) the Brief-IPQ sum scores for these subgroups were 42.0, 28.2, 38.8, and 33.3, respectively. Corrected for age, sex, hand dominance, and work type, patients with Dupuytren disease had a more positive perception of their illness than patients with CMC OA and CTS. Compared with CMC OA patients, the effect sizes for Dupuytren, CTS, and TFS patients were, respectively, 1.28, 0.32, and 0.81. CONCLUSIONS In these patients with various hand/wrist disorders, differences were found in their preoperative perceptions of illness. Interventions that directly target negative illness perceptions might improve treatment outcomes for CMC OA and CTS. CLINICAL RELEVANCE These differences should be considered during preoperative medical consultations and/or when investigating surgical outcomes.
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CORR Insights®: Can an Integrative Care Approach Improve Physical Function Trajectories after Orthopaedic Trauma? A Randomized Controlled Trial. Clin Orthop Relat Res 2020; 478:805-807. [PMID: 32118608 PMCID: PMC7282567 DOI: 10.1097/corr.0000000000001195] [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: 01/31/2023]
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Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis. J Hand Surg Am 2020; 45:123-130.e1. [PMID: 31859053 DOI: 10.1016/j.jhsa.2019.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Operative treatment of trapeziometacarpal osteoarthritis (TMC OA) is discretionary. There is substantial surgeon-to-surgeon variation in offers of surgery. This study assessed factors associated with variation in recommendation of operative treatment to patients with TMC OA. Secondarily, we studied factors associated with preferred operative technique and surgeon demographic factors variability in recommendation for operative treatment. METHODS We invited all hand surgeon members of the Science of Variation Group to review 16 scenarios of patients with TMC OA and asked the surgeons whether they would recommend surgical treatment for each patient and, if yes, which surgical technique they would offer (trapeziectomy, trapeziectomy with ligament reconstruction and/or tendon interposition, joint replacement, or arthrodesis). Scenarios varied in pain intensity, relief after injection, radiographic severity, and psychosocial symptoms. RESULTS Patient characteristics associated with greater likelihood to recommend surgical treatment were substantial pain, a previous injection that did not relieve pain, radiograph with severe TMC OA, and few symptoms of depression. Practice region was the only factor associated with preferred surgical technique and trapeziectomy with ligament reconstruction and/or tendon interposition the most commonly recommended treatment. There was low agreement among surgeons regarding treatment recommendations. CONCLUSIONS The notable variation in offers of operative treatment for TMC OA is largely associated with variable attention to subjective factors. Future studies might address the relative influence of surgeon incentives and beliefs, objective pathophysiology, and subjective patient factors on variation in surgeon recommendations. CLINICAL RELEVANCE Surgeons' awareness of the potential influence of subjective factors on their recommendations might contribute to efforts to ensure that patient choices reflect what matters most to them and are not based on misconceptions.
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CORR Insights®: Does Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity? Clin Orthop Relat Res 2020; 478:389-391. [PMID: 31855591 PMCID: PMC7438154 DOI: 10.1097/corr.0000000000001098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Sun PO, Walbeehm ET, Selles RW, Jansen MC, Slijper HP, Ulrich DJO, Porsius JT. Influence of illness perceptions, psychological distress and pain catastrophizing on self-reported symptom severity and functional status in patients with carpal tunnel syndrome. J Psychosom Res 2019; 126:109820. [PMID: 31487574 DOI: 10.1016/j.jpsychores.2019.109820] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the influence of illness perceptions, pain catastrophizing and psychological distress on self-reported symptom severity and functional status in patients diagnosed with carpal tunnel syndrome (CTS). METHODS A total of 674 patients with CTS scheduled for surgery at an outpatient treatment center for hand and wrist conditions (September 2017 to August 2018) completed online questionnaires regarding demographic and psychosocial characteristics and self-reported CTS severity. Self-reported severity of CTS was measured with the functional status scale and the symptom severity scale of the Boston Carpal Tunnel Questionnaire. To measure psychosocial factors, the Patient Health Questionnaire-4, Pain Catastrophizing Scale and the Brief Illness Perception Questionnaire were used. Pearson correlation coefficients were calculated to assess univariable relations. Hierarchical linear regression models were used to examine the relation between psychosocial factors and self-reported severity, and the relative contribution of psychosocial factors to self-reported severity, adjusting for patient characteristics and comorbidities. RESULTS Medium-sized correlations (range 0.32-0.44) with self-reported severity were observed for psychological distress, pain catastrophizing, consequences, identity, concern and emotional representation. Furthermore, these factors (except for concern) were also associated with self-reported severity, when adjusted for baseline characteristics and comorbidities. Hierarchical linear regression models showed that these psychosocial factors explained an additional 20-25% of the variance in self-reported severity of CTS. CONCLUSION This study shows that psychological distress, pain catastrophizing and illness perceptions play an independent role in self-reported severity of CTS. Clinicians should take these psychosocial factors into account when they are consulted by patients with CTS.
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Affiliation(s)
- Pepijn O Sun
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Erik T Walbeehm
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinic, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Miguel C Jansen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dietmar J O Ulrich
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, The Netherlands; Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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What Role Does Positive Psychology Play in Understanding Pain Intensity and Disability Among Patients with Hand and Upper Extremity Conditions? Clin Orthop Relat Res 2019; 477:1769-1776. [PMID: 31107321 PMCID: PMC7000013 DOI: 10.1097/corr.0000000000000694] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A large body of research shows that psychologic distress and ineffective coping strategies substantially contribute to more severe pain and increased physical limitations among patients with orthopaedic disorders. However, little is known about the relationship between positive psychology (constructs that enable individuals to thrive and adapt to challenges) and pain and physical limitations in this population. QUESTIONS/PURPOSES (1) Which positive-psychology factors (satisfaction with life, gratitude, coping through humor, resilience, mindfulness, and optimism) are independently associated with fewer upper-extremity physical limitations after controlling for the other clinical and demographic variables? (2) Which positive-psychology factors are independently associated with pain intensity after controlling for relevant clinical and demographic variables? METHODS In a cross-sectional study, we recruited patients presenting for a scheduled appointment with an orthopaedic surgeon at a hand and upper-extremity clinic of a major urban academic medical center. Of 125 approached patients, 119 (44% men; mean age, 50 ± 17 years) met screening criteria and agreed to participate. Patients completed a clinical and demographic questionnaire, the Numerical Rating Scale to assess pain intensity, the Patient-reported Outcomes Measurement Information System (PROMIS) Upper Extremity Physical Function computerized adaptive test to assess physical limitations, and six measures assessing positive-psychology constructs: The Satisfaction with Life Scale, the Gratitude Questionnaire, the Coping Humor Scale, the Brief Resilience Scale, the Cognitive and Affective Mindfulness Scale-Revised, and the Life Orientation Test-Revised. We first examined bivariate associations among physical limitations, pain intensity, and all positive-psychology factors as well as demographic and clinical variables. All variables that demonstrated associations with physical limitations or pain intensity at p < 0.05 were included in two-stage multivariable hierarchical regression models. RESULTS After controlling for the potentially confounding effects of prior surgical treatment and duration since pain onset (step1; R total = 0.306; F[7,103] = 6.50), the positive-psychology variables together explained an additional 15% (R change = 0.145, F change [5, 103] = 4.297, p = 0.001) of the variance in physical limitations. Among the positive-psychology variables tested, mindfulness was the only one associated with fewer physical limitations (β = 0.228, t = 2.293, p = 0.024, 4% variance explained). No confounding demographic or clinical variables were found for pain intensity in bivariate analyses. All positive-psychology variables together explained 23% of the variance in pain intensity (R = 0.23; F[5,106] = 6.38, p < 0.001). Among the positive-psychology variables, satisfaction with life was the sole factor independently associated with higher intensity (β = -0.237, t = -2.16, p = 0.033, 3% variance explained). CONCLUSIONS Positive-psychology variables explained 15% of the variance in physical limitations and for 23% of the variance in pain intensity among patients with heterogenous upper extremity disorders within a hand and upper extremity practice. Of all positive-psychology factors, mindfulness and satisfaction with life were most important for physical limitations and pain intensity, respectively. As positive-psychology factors are more easily modifiable through skills-based interventions than pain and physical limitations, results suggest implementation of such interventions to potentially improve outcomes in this population. Skills-based interventions targeting mindfulness and satisfaction with life may be of particular benefit. LEVEL OF EVIDENCE Level II, prognostic study.
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Bargon CA, Zale EL, Magidson J, Chen N, Ring D, Vranceanu AM. Factors Associated With Patients' Perceived Importance of Opioid Prescribing Policies in an Orthopedic Hand Surgery Practice. J Hand Surg Am 2019; 44:340.e1-340.e8. [PMID: 30122303 DOI: 10.1016/j.jhsa.2018.06.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/18/2018] [Accepted: 06/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to survey the attitudes and beliefs about opioids and opioid prescribing policies among patients presenting to an orthopedic hand surgery practice. METHODS Patients (n = 118; median age, 49 years) who presented to their regularly scheduled appointment at a major urban university medical center completed surveys assessing their sociodemographic and clinical characteristics, beliefs about prescription opioids, beliefs about opioid prescribing policies, and perceived importance of opioid prescribing policies in the department. RESULTS Many patients were aware of potential risks of opioids (eg, 80% are aware of addictive properties) and would support opioid prescribing policies that aim to decrease opioid misuse and diversion. However, a small but important number of patients have concerning beliefs about prescription opioids (eg, 28% believe opioids work well for long-term pain) or believe that doctors should prescribe "as much medication as the patient needs" (7%). The vast majority (98%) indicated that they would like more education on opioids and that information about prescription opioids should be provided to all patients in orthopedic practices. Patients with higher educational attainment reported a greater perceived importance of opioid prescribing policies. CONCLUSIONS The results of this study suggest that opioid prescribing strategies that promote safe and effective alleviation of pain and optimal opioid stewardship will be well received by patients. CLINICAL RELEVANCE Efforts to develop and test the effects of opioid prescribing policies and nonopioid pain relief strategies on opioid prescribing are merited.
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Affiliation(s)
- Claudia Antoinette Bargon
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA; University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Emily L Zale
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Jessica Magidson
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Neal Chen
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - David Ring
- Orthopaedic Hand Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA; Dell Medical School, The University of Texas, Austin, TX
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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Dy CJ. What's New in Hand Surgery. J Bone Joint Surg Am 2019; 101:479-485. [PMID: 30893228 DOI: 10.2106/jbjs.18.01325] [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: 02/01/2023]
Affiliation(s)
- Christopher J Dy
- Division of Hand and Microsurgery, the Department of Orthopaedic Surgery, and the Division of Public Health Sciences, the Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
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Use of simulation in the rehabilitation of an anesthesiologist injured in the workplace. Can J Anaesth 2019; 66:744-745. [DOI: 10.1007/s12630-019-01347-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/25/2019] [Accepted: 03/05/2019] [Indexed: 11/25/2022] Open
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Vranceanu AM, Jacobs C, Lin A, Greenberg J, Funes CJ, Harris MB, Heng MM, Macklin EA, Ring D. Results of a feasibility randomized controlled trial (RCT) of the Toolkit for Optimal Recovery (TOR): a live video program to prevent chronic pain in at-risk adults with orthopedic injuries. Pilot Feasibility Stud 2019; 5:30. [PMID: 30820341 PMCID: PMC6381627 DOI: 10.1186/s40814-019-0416-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthopedic injuries are the leading cause of hospital admissions in the USA, and many of these patients transition into chronic pain. Currently, there are no evidence-based interventions targeting prevention of chronic pain in patients with orthopedic injuries. We iteratively developed a four-session intervention "The Toolkit for Optimal Recovery" (TOR) which we plan to subsequently test for efficacy in a phase III hybrid efficacy-effectiveness multi-site clinical trial. In order to prevent methodological weaknesses in the subsequent trial, we conducted a feasibility pilot to evaluate the TOR delivered via secure live video versus usual care (UC) in patients with orthopedic injuries from an urban, level I trauma clinic, who screen in as at risk for chronic pain and disability. We tested the feasibility of recruitment, acceptability of screening, and randomization methods; acceptability of the intervention, treatment adherence, and treatment fidelity; satisfaction with the intervention; feasibility of the assessment process at all time points; acceptability of outcome measures for the definitive trial; and within-treatment effect sizes. METHODS We aimed to recruit 50-60 participants, randomize, and retain them for ~ 4 months. Assessments were done electronically via REDCap at baseline, post-intervention (approximately 5 weeks after baseline), and 3 months later. We followed procedures we intend to implement in the full-scale hybrid efficacy-effectiveness trial. RESULTS We recruited 54 participants and found that randomization and data collection procedures were generally acceptable. The majority of participants were white, educated, and employed. Warm hand-off referrals were more effective than research assistants directly approaching patients for participation without their providers' engagement. Feasibility of recruitment, acceptability of screening, and randomization were good. Satisfaction with the program, adherence to treatment sessions, and treatment fidelity were all high. There were no technical issues associated with the live video delivery of the TOR. There was minimal missing data and outcome measures were deemed appropriate. Effect sizes for improvement after participation in TOR were moderate to large. There were many lessons learned for future trials. CONCLUSIONS This study provided evidence of the feasibility of the planned hybrid efficacy-effectiveness trial design when implemented at our home institution. Establishing feasibility of the intervention and study procedures at other trauma centers with more diverse patient populations and different clinical practices is required before a multi-site phase III efficacy-effectiveness trial. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03405610. Registered on January 28, 2018-retrospectively registered.
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Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Cale Jacobs
- Department of Orthopedic Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA 02114 USA
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Christopher J. Funes
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA 02114 USA
| | - Mitchel B. Harris
- Harvard Medical School, Boston, MA USA
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Marilyn M. Heng
- Harvard Medical School, Boston, MA USA
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Eric A. Macklin
- Harvard Medical School, Boston, MA USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA USA
| | - David Ring
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical Center, Austin, TX USA
- The University of Texas at Austin Dell Medical School, Austin, TX USA
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