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Duarte BA, Mace RA, Doorley JD, Penn TM, Bakhshaie J, Vranceanu AM. Breaking the Disability Spiral: A Case Series Report Illustrating the Delivery of a Brief Skills Based Coaching Intervention to Prevent Chronic Dysfunction and Pain After Orthopedic Injury. J Clin Psychol Med Settings 2024; 31:91-107. [PMID: 37249719 DOI: 10.1007/s10880-023-09959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/31/2023]
Abstract
Orthopedic traumas are common, costly, and burdensome - particularly for patients who transition from acute to chronic pain. Psychosocial factors, such as pain catastrophizing and pain anxiety, increase risk for poor outcomes after injury. The Toolkit for Optimal Recovery (TOR) is a novel multi-component mind-body intervention informed by the fear-avoidance model to promote re-engagement in daily activities and prevent transition toward chronic pain and physical dysfunction. The current case series aims to 1) describe the intervention and 2) showcase the treatment course of three TOR completers from diverse geographic locations in the U.S. with distinct injury types and varying personal identities to illustrate how the intervention can be delivered flexibly. Results indicate pre-to-post program improvement in physical function, pain severity, pain catastrophizing, pain anxiety, and other relevant outcomes targeted by the intervention (i.e., depression, mindfulness, coping). Experiences of our three TOR completers suggest that integrating TOR with standard orthopedic care may promote physical recovery after injury.
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Affiliation(s)
- Brooke A Duarte
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Department of Psychology, Suffolk University, Boston, MA, USA
| | - Ryan A Mace
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James D Doorley
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Terence M Penn
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jafar Bakhshaie
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research (CHOIR), Massachusetts General Hospital, One Bowdoin Square, Suite 100, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Reichman M, Briskin EA, Duarte BA, Vranceanu AM, Grunberg VA. Integrating Psychosocial Care into Orthopedic Settings: A Qualitative Study of Provider Perspectives. Int J Integr Care 2023; 23:15. [PMID: 38074513 PMCID: PMC10705025 DOI: 10.5334/ijic.7579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/12/2023] [Indexed: 01/31/2024] Open
Abstract
Introduction Approximately 50% of persons with orthopedic injuries experience psychosocial distress (e.g., depression, anxiety), which can predict chronic pain and disability. Offering psychosocial services in orthopedic settings can promote patient recovery. This study explores health care professionals' perceptions of and recommendations regarding integrated psychosocial care for orthopedic settings. Methods We conducted 18 semi-structured focus groups with 79 orthopedic health care professionals (e.g., surgeons, residents, nurses) across three Level I Trauma Centers. This secondary data analysis used the evidence-based Rainbow Model of Integrated Care framework to structure hybrid inductive-deductive qualitative data analysis. Results Orthopedic health care professionals identified potential benefits to psychosocial service integration across all dimensions of integration (i.e., clinical, professional, organizational, system, functional, and normative). These benefits included increased patient satisfaction with care, decreased burden on medical providers to manage patient distress, and decreased healthcare utilization costs. They also identified barriers (e.g., fast-paced clinic flow, mental health stigma) and offered recommendations to address barriers across dimensions of integration. Conclusion Integrated psychosocial care for orthopedic trauma patients has the potential to improve patient recovery and long-term physical and mental health outcomes. This work identifies strategies to inform the development and implementation of initiatives to integrate psychosocial services within orthopedic settings.
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Affiliation(s)
- Mira Reichman
- University of Washington, Department of Psychology, Seattle, WA, USA
| | - Ellie A. Briskin
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brooke A. Duarte
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Suffolk University, Department of Psychology, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria A. Grunberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, MassGeneral for Children, Boston, Massachusetts, 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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Myhre L, Featherall J, O’Neill D, Rothberg D, Haller J, Higgins T, Marchand L. Patient-reported Anxiety Scores Are Associated With Lower Physical Function in Patients Experiencing Orthopaedic Trauma. Clin Orthop Relat Res 2023; 481:967-973. [PMID: 36728246 PMCID: PMC10097580 DOI: 10.1097/corr.0000000000002516] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The outcomes of orthopaedic trauma are not solely determined by injury severity or surgical treatment. Studies of numerous orthopaedic outcomes have found that psychosocial factors are also important. Symptoms of anxiety have been linked to long-term pain and disability. Although the existence of a relationship between psychosocial factors and functional outcomes is accepted across multiple disciplines, quantification of this association in patients who have experienced orthopaedic trauma has remained limited. Measuring the anxiety experienced by these individuals and the association with long-term functional outcomes remain poorly understood. QUESTIONS/PURPOSES (1) Is there an association between early postoperative anxiety symptoms and late recovery of self-reported physical function in patients with orthopaedic trauma? (2) What was the impact of other factors such as demographic variables and comorbidities on late recovery physical function scores, and how did the magnitude of these factors compare with the association with anxiety score? (3) Did patients who presented as trauma activations differ regarding their anxiety symptoms and late-recovery self-reported physical function? METHODS A total of 1550 patients with lower extremity fractures and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and physical function scores treated between January 1, 2014, and January 1, 2021, at an academic Level I trauma center in North America were assessed. We performed a bivariate regression between the initial PROMIS anxiety and physical function, as well as a multivariate regression including age, gender, BMI, and American Society of Anesthesiologists class to control for potential confounding variables. In a subgroup of 787 patients presenting as trauma activations, we performed a separate regression including Injury Severity Score. RESULTS PROMIS anxiety was associated with decreased late-recovery physical function (β = -2.64 [95% CI -3.006 to -2.205]; p < 0.001). The relationship between PROMIS anxiety and physical function remained after controlling for confounding variables in our overall cohort (β = -2.54 [95% CI -2.93 to -2.15]; p < 0.001) and in the trauma activation cohort (β = -2.71 [95% CI -3.19 to -2.23]; p < 0.001). Age and American Society of Anesthesiologists score were associated with worse PROMIS physical function scores, while being a man was associated with better PROMIS physical function scores (age: β= -1.26 [95% CI -1.50 to -1.02]; American Society of Anesthesiologists class: β=-2.99 [95% CI -3.52 to -2.46]; men: β = 0.95 [95% CI 0.16 to 1.75]). There were no differences in initial anxiety symptoms or late-recovery physical function between patients who presented as trauma activations and those who did not. Injury Severity Scores were independently associated with worse function (β = -1.45 [95% CI -2.11 to -0.79]. CONCLUSION Initial patient self-reported anxiety is negatively associated with patient-reported physical function at the final follow-up interval in a broad cohort of patients with orthopaedic lower extremity injuries undergoing surgery. Identifying patients with high initial PROMIS anxiety scores may allow us to determine which patients will report lower functional scores at the final follow-up. Future investigations could focus on the effect of psychosocial interventions such as cognitive behavioral therapy and mindfulness on functional scores. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Luke Myhre
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Joseph Featherall
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Dillon O’Neill
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - David Rothberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Justin Haller
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Thomas Higgins
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Lucas Marchand
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Sun W, Chen C, Jiang X, Hua K, Zha Y, Gong M, Xiao D, Zhao X. Anxiety and depression are associated with poor outcomes in open elbow arthrolysis. Injury 2023:110713. [PMID: 37270347 DOI: 10.1016/j.injury.2023.03.041] [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: 02/01/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Open elbow arthrolysis (OEA) is an established treatment for posttraumatic elbow stiffness (PTES); however, its efficacy is debatable for some patients. Poor surgical outcomes have been associated with anxiety and depression in other orthopedic conditions, but no studies have examined this association in OEA. In this study, we aimed to determine whether a high preoperative anxiety and depression score is associated with a worse functional outcome in OEA for PTES. METHODS A retrospective review of prospectively collected data was carried out in patients undergoing OEA between April 2021 and March 2022. Mental state evaluated by Hospital Anxiety and Depression Scale (HADS), subjective elbow function valued by Disabilities of the Arm, Shoulder, and Hand (DASH) score, objective elbow function valued by Mayo Elbow Performance Score (MEPS), pain score measured by visual analog scale (VAS) and the flexion-extension range of motion (ROM) of the affected elbow were collected before and after surgery in outpatient clinic follow-up at 3 months and 6 months. Patient satisfaction was only recorded 6 months postoperatively. All patients were divided into 2 groups based on the preoperative HADS score for analysis: Group A was the nonanxiety-depression group, and Group B was the anxiety-depression group. RESULTS A total of 49 patients were included. Both groups improved in DASH, MEPS and ROM at 3 months and at 6 months. The HADS score in Group B decreased significantly at 6 months, showing that the mental state of patients in Group B improved after surgery. Group A had a lower DASH at 3 months and 6 months, larger 6-month ROM and higher satisfaction rate than Group B. Comparing the differences between preoperative and postoperative measurements, Group A improved more in ROM at 6 months. There was no significant difference in other outcome measures between the two groups. CONCLUSIONS OEA is a safe and effective treatment for PTES, and can achieve good clinical outcomes in the short-term follow-up, regardless of whether the patients suffer from anxiety or depression. Patients with a HADS score ≥11 before OEA, however, have worse outcomes than those with a HADS score <11. LEVEL OF EVIDENCE Level II; Retrospective Design; Prognosis Study.
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Affiliation(s)
- Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China.
| | - Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Dan Xiao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xian Zhao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing 100035, China
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Karartı C, Basat HÇ, Özsoy İ, Özyurt F, Özsoy G, Kodak Mİ, Özüdoğru A, Uçar İ. Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool. Indian J Orthop 2023; 57:124-136. [PMID: 36660479 PMCID: PMC9789244 DOI: 10.1007/s43465-022-00781-7] [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: 03/22/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
Introduction Although the negative effects of kinesiophobia on functional status in subacromial pain syndrome (SAPS) patients are clearly demonstrated, no study examines the risk factors of kinesiophobia in individuals with SAPS from a biopsychosocial perspective. The present study aims to determine the risk factors of kinesiophobia in individuals with SAPS using a biopsychosocial approach. This study also aims to explore the compounding effects of multiple associative risk factors by developing a clinical prediction tool to identify SAPS patients at higher risk for kinesiophobia. Materials and methods This cross-sectional study included 549 patients who were diagnosed with SAPS. The Tampa-Scale of Kinesiophobia (TSK) was used to assess kinesiophobia. Visual analog scale (VAS), The Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the presence of metabolic syndrome, using any non-steroidal anti-inflammatory drugs, Pain Catastrophizing Scale (PCS), Illness Perception Questionnaire-revised (IPQ-R), Hospital Anxiety and Depression Scale (HADS), behavioral pattern of the patient, sociodemographic characteristics, and treatment expectancy were outcome measures. Results Thirteen significant risk factors of having kinesiophobia were: VASat rest (≥ 5.2), VASduring activity (≥ 7.1), DASH (≥ 72.1), presence of metabolic syndrome, PCShelplessness (≥ 16.1), IPQ-Rpersonal control (≤ 17.1), IPQ-Rtreatment control (≤ 16.3), HADSdepression (≥ 7.9), avoidance behavior type, being female, educational level (≤ high school), average hours of sleep (≤ 6.8), and treatment expectancy (≤ 6.6). The presence of seven or more risk factors increased the probability of having high level of kinesiophobia from 34.3 to 51%. Conclusions It seems necessary to address these factors, increase awareness of health practitioners and individuals. Level of evidence Level IV.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Fatih Özyurt
- Department of Physiotherapy and Rehabilitation, Beykent University, Istanbul, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Anatomy, Erciyes University, Kayseri, Turkey
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De Ridder WA, Wouters RM, Hoogendam L, Vermeulen GM, Slijper HP, Selles RW. Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis. Clin Orthop Relat Res 2022; 480:1287-1301. [PMID: 34982052 PMCID: PMC9191327 DOI: 10.1097/corr.0000000000002107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Satisfaction with treatment results is an important outcome domain in striving for patient-centered and value-based healthcare. Although numerous studies have investigated factors associated with satisfaction with treatment results, most studies used relatively small samples. Additionally, many studies have only investigated univariable associations instead of multivariable associations; to our knowledge, none have investigated the independent association of baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health with satisfaction with treatment results. QUESTIONS/PURPOSES (1) What factors are independently associated with satisfaction with treatment results at 3 months post-treatment in patients treated for common hand and wrist conditions? (2) What factors are independently associated with the willingness to undergo the treatment again at 3 months post-treatment in patients treated for common hand and wrist conditions? Among the factors under study were baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health. METHODS Between August 2018 and May 2020, we included patients who underwent carpal tunnel release, nonsurgical or surgical treatment for thumb-base osteoarthritis, trigger finger release, limited fasciectomy for Dupuytren contracture, or nonsurgical treatment for midcarpal laxity in one of the 28 centers of Xpert Clinics in the Netherlands. We screened 5859 patients with complete sociodemographics and data at baseline. Thirty-eight percent (2248 of 5859) of these patients had complete data at 3 months. Finally, participants were eligible for inclusion if they provided a relevant answer to the three patient-reported experience measure (PREM) items. A total of 424 patients did not do this because they answered "I don't know" or "not applicable" to a PREM item, leaving 31% (1824 of 5859) for inclusion in the final sample. A validated Satisfaction with Treatment Result Questionnaire was administered at 3 months, which identified the patients' level of satisfaction with treatment results so far on a 5-point Likert scale (research question 1, with answers of poor, moderate, fair, good, or excellent) and the patients' willingness to undergo the treatment again under similar circumstances (research question 2, with answers of yes or no). A hierarchical logistic regression model was used to identify whether baseline sociodemographics, quality of life, change in outcome (patient-reported outcome measures for hand function and pain), baseline measures of mental health (including treatment credibility [the extent to which a patient attributes credibility to a treatment] and expectations, illness perception, pain catastrophizing, anxiety, and depression), and PREMs were associated with each question of the Satisfaction with Treatment Result Questionnaire at 3 months post-treatment. We dichotomized responses to our first question as good and excellent, which were considered more satisfied, and poor, moderate, and fair, which were considered less satisfied. After dichotomization, 57% (1042 of 1824) of patients were classified as more satisfied with the treatment results. RESULTS The following variables were independently associated with satisfaction with treatment results, with an area under the curve of 0.82 (95% confidence interval 0.80 to 0.84) (arranged from the largest to the smallest standardized odds ratio [SOR]): greater decrease in pain during physical load (standardized odds ratio 2.52 [95% CI 2.18 to 2.92]; p < 0.001), patient's positive experience with the explanation of the pros and cons of the treatment (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 1.83 [95% CI 1.41 to 2.38]; p < 0.001), greater improvement in hand function (SOR 1.76 [95% CI 1.54 to 2.01]; p < 0.001), patients' positive experience with the advice for at-home care (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.57 [95% CI 1.21 to 2.04]; p < 0.001), patient's better personal control (determined with the question: "How much control do you feel you have over your illness?") (SOR 1.24 [95% CI 1.1 to 1.40]; p < 0.001), patient's more positive treatment expectations (SOR 1.23 [95% CI 1.04 to 1.46]; p = 0.02), longer expected illness duration by the patient (SOR 1.20 [95% CI 1.04 to 1.37]; p = 0.01), a smaller number of symptoms the patient saw as part of the illness (SOR 0.84 [95% CI 0.72 to 0.97]; p = 0.02), and less concern about the illness the patient experiences (SOR 0.84 [95% CI 0.72 to 0.99]; p = 0.04). For willingness to undergo the treatment again, the following variables were independently associated with an AUC of 0.81 (95% CI 0.78 to 0.83) (arranged from the largest to the smallest standardized OR): patient's positive experience with the information about the pros and cons (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 2.05 [95% CI 1.50 to 2.80]; p < 0.001), greater improvement in hand function (SOR 1.80 [95% CI 1.54 to 2.11]; p < 0.001), greater decrease in pain during physical load (SOR 1.74 [95% CI 1.48 to 2.07]; p < 0.001), patient's positive experience with the advice for at home (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.52 [95% CI 1.11 to 2.07]; p = 0.01), patient's positive experience with shared decision-making (determined with the question: "Did you decide together with the care providers which care or treatment you will receive?") (SOR 1.45 [95% CI 1.06 to 1.99]; p = 0.02), higher credibility the patient attributes to the treatment (SOR 1.44 [95% CI 1.20 to 1.73]; p < 0.001), longer symptom duration (SOR 1.27 [95% CI 1.09 to 1.52]; p < 0.01), and patient's better understanding of the condition (SOR 1.17 [95% CI 1.01 to 1.34]; p = 0.03). CONCLUSION Our findings suggest that to directly improve satisfaction with treatment results, clinicians might seek to: (1) improve the patient's experience with healthcare delivery, (2) try to influence illness perception, and (3) boost treatment expectations and credibility. Future research should confirm whether these suggestions are valid and perhaps also investigate whether satisfaction with treatment results can be predicted (instead of explained, as was done in this study). Such prediction models, as well as other decision support tools that investigate patient-specific needs, may influence experience with healthcare delivery, expectations, or illness perceptions, which in turn may improve satisfaction with treatment results. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Willemijn Anna De Ridder
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
- Center for Hand Therapy, Xpert Handtherapie, Utrecht, the Netherlands
| | - Robbert Maarten Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | | | - Harm Pieter Slijper
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Ruud Willem Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Brindisino F, Silvestri E, Gallo C, Venturin D, Di Giacomo G, Peebles AM, Provencher MT, Innocenti T. Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1219-e1234. [PMID: 35747628 PMCID: PMC9210488 DOI: 10.1016/j.asmr.2022.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS). Methods Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (≥ 30 < 70 years old) with FSCS. Results Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline. Conclusion Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | | | | | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | | | - Matthew T Provencher
- Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.,GIMBE Foundation, Bologna, Italy
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Rossano A, Al Salman A, Ring D, Guzman JM, Fatehi A. Do Unhelpful Thoughts or Confidence in Problem Solving Have Stronger Associations with Musculoskeletal Illness? Clin Orthop Relat Res 2022; 480:287-295. [PMID: 34705738 PMCID: PMC8747486 DOI: 10.1097/corr.0000000000002005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Measures of unhelpful thoughts and distress correlate with the intensity of pain and the magnitude of incapability among people seeking musculoskeletal specialty care. In this evolving knowledge area, we want to be sure we have not neglected other important mental health factors. This study addressed how measures of confidence in problem solving as well as past and current ability to achieve goals account for variation in symptoms and capability independent of unhelpful thoughts and distress. QUESTIONS/PURPOSES (1) Are measures of confidence in problem solving ability and past and current ability to achieve goals regarding future outcomes associated with variation in capability, independent of measures of symptoms of depression and anxiety (distress) and measures of unhelpful thoughts (worst-case thinking, negative pain thoughts)? (2) Are these measures independently associated with variation in pain intensity? (3) Are these measures associated with measures of symptoms of depression, symptoms of anxiety, and unhelpful thoughts? METHODS Over a 7-month period during the pandemic, we enrolled sporadically from the offices of four surgeons treating patients who sought care for various upper and lower extremity conditions. We invited approximately 200 adult new and returning patients to participate (the number of invitations was not formally tracked) and 187 accepted. Thirty-one were excluded due to markedly incomplete entries (related to a problematic attempt to use the patient's cell phone to complete questionnaires as a pandemic work around), leaving 156 for analysis. Patients completed an 11-point ordinal rating of pain intensity, two measures of unhelpful thoughts (the Pain Catastrophizing Scale and the Negative Pain Thoughts Questionnaire), the Adult Hope Scale to measure past and current ability to achieve goals, the Personal Optimism and Self-Efficacy Optimism Scale to measure confidence in problem solving ability, the Patient-reported Outcomes Measurement Information System (PROMIS) computer adaptive test to measure symptoms of anxiety, the PROMIS computer adaptive test to measure symptoms of depression, and the PROMIS physical function computer adaptive test to assess the magnitude of capability. All questionnaires were validated in previous studies. We used bivariate analyses to identify factors associated with magnitude of capability, pain intensity, confidence in problem solving ability, and past and current ability to achieve goals. All factors with a p value of less than 0.1 were included in multivariable analyses to seek associations between these measures accounting for confounders. We reported partial η2 as a measure of effect size for all multivariable regression models. The following rules of thumb are used to interpret values for partial η2: a value of 0.01 = small, 0.06 = medium, and values of 0.14 and higher show large effect size. RESULTS Greater capability was modestly associated with fewer negative pain thoughts (β = -0.63 [95% CI -1.0 to -0.22]; standard error = 0.20; partial η2 = 0.06; p = 0.003) and no self-reported comorbidities (β = 2.6 [95% CI 0.02 to 5.3]; standard error = 1.3; partial η2 = 0.03; p = 0.048) after controlling for education, symptoms of depression and anxiety, worst-case thinking, as well as past and current ability to achieve goals. In a similar multivariable model, greater pain intensity was modestly associated with greater worst-case thinking (β = 0.33 [95% CI 0.20 to 0.45]; standard error = 0.06; partial η2 = 0.16; p < 0.001) and established patients (β = -1.1 [95% CI -1.8 to -0.31]; standard error = 0.38; partial η2 = 0.05; p = 0.006). In another similar multivariable model, having more confidence in problem solving ability had a limited association with higher ratings of past and current ability to achieve goals (β = 0.15 [95% CI 0.09 to 0.21]; standard error = 0.03; partial η2 = 0.13; p < 0.001). In a final multivariable model, lower past and current ability to achieve goals was independently associated with having greater symptoms of depression (β = -0.45 [95% CI -0.67 to -0.23]; standard error = 0.11; partial η2 = 0.1; p < 0.001) and more negative pain thoughts (β = -0.49 [95% CI -0.89 to -0.09]; standard error = 0.20; partial η2 = 0.04; p = 0.02). CONCLUSION The observation that unhelpful thoughts about symptoms are more strongly associated with symptom intensity than past and current ability to achieve goals and confidence in problem solving ability add to the evidence that attentiveness to unhelpful thinking is an important aspect of musculoskeletal health. Musculoskeletal specialists can prioritize communication strategies such as relationship building and motivational interviewing that develop trust and facilitate reorientation of common unhelpful thoughts. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Ayane Rossano
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Aresh Al Salman
- 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
| | - J. Mica Guzman
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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10
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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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11
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Su C, Ren X, Wang H, Ding X, Guo J. Changing Pain Management Strategy from Opioid-Centric towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine. Curr Drug Metab 2021; 23:57-65. [PMID: 34791997 DOI: 10.2174/1389200222666211118115347] [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: 05/16/2021] [Revised: 08/21/2021] [Accepted: 09/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. METHODS One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. RESULTS The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). CONCLUSION Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioid-centric towards improved postoperative cognitive dysfunction.
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Affiliation(s)
- Chunhong Su
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaojun Ren
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Hongpei Wang
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Xiaomei Ding
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
| | - Jian Guo
- Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu. China
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12
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Kortlever JTP, Karyampudi P, Ottenhoff JSE, Ring D, Vagner GA, Reichel LM. Using the Tampa Scale for Kinesiophobia Short Form in Patients With Upper Extremity Specific Limitations. Hand (N Y) 2021; 16:847-853. [PMID: 31965855 PMCID: PMC8647314 DOI: 10.1177/1558944719898830] [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] [Indexed: 02/10/2023]
Abstract
Background: The Tampa Scale for Kinesiophobia (TSK) is used to quantify fear of painful movement. A shorter form with only 4 questions (TSK-4) can be used by physicians to look for fear of movement independent of catastrophic thinking with less responder and survey burden. We assessed the difference explained in amount of variation in the Patient-Reported Outcomes Measurement Information System Physical Function Upper Extremity (PROMIS PF UE) between the TSK and TSK-4. Additionally, we looked for other factors that were associated with the PROMIS PF UE, and we assessed reliability and validity of the TSK and TSK-4 by looking at mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression, and PROMIS Pain Interference (PROMIS PI). Methods: One hundred forty eight new and follow-up patients were seen at 5 orthopedic clinics in a large urban area and given the TSK, PROMIS PF UE, PROMIS Depression, PROMIS PI, and PCS-4 questionnaires. Results: Both long and short measures of greater fear of painful movement were independently associated with less physical function (PROMIS PF UE). The longer version accounted for more of the variation in physical function than the short version (TSK, semipartial R2 = 0.12, adjusted R2 full model 0.25; TSK-4, semipartial R2 = 0.03, adjusted R2 full model = 0.16, respectively). The shorter measure had slight floor and ceiling effects. There was high internal consistency for both the TSK and TSK-4. Conclusions: A short measure of fear of painful movement may be an adequate screen in the care of patients with upper extremity problems. Using this short form can help decrease questionnaire burden while accounting for kinesiophobia along with catastrophic thinking.Level of Evidence: Prognostic, level II.
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Affiliation(s)
| | | | | | - David Ring
- The University of Texas at Austin, USA,David Ring, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX 78712, USA.
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13
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DEMİR B, AKALTUN MS, ALTINDAĞ Ö, KARAOGLAN H, ALTINDAĞ A, GÜRSOY S, GÜR A. Anxiety, health anxiety and somatosensory amplification levels in individuals with carpal tunnel syndrome with normal electromyography. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.903677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Tran TT, Kortlever JTP, Teunis T, Ring D, Vagner GA, Reichel LM. Attitudes Toward Aging Among Patients With Upper Extremity Illness. Hand (N Y) 2021; 16:354-361. [PMID: 31378085 PMCID: PMC8120584 DOI: 10.1177/1558944719866872] [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] [Indexed: 11/16/2022]
Abstract
Background: An adaptive attitude toward aging might limit symptom intensity and magnitude of limitations. This study sought factors associated with attitudes toward aging (measured with the Brief Aging Perceptions Questionnaire [B-APQ]) and studied the relationship of having an age-related disease to magnitude of limitations, pain intensity, patient satisfaction, and patient comfort with completing a questionnaire about attitudes toward aging. We also looked for a subset of questions from B-APQ that maintained the construct validity and internal consistency of B-APQ, without unacceptable flooring or ceiling effects. Methods: A total of 161 upper extremity patients completed the following questionnaires: B-APQ, Patient Health Questionnaire-Short Form, Pain Self-efficacy-Short Form, Pain Catastrophizing Scale-Short Form, Patient-Reported Outcomes Measurement Information System Physical Function-Upper Extremity, pain intensity, satisfaction with the surgeon, and comfort with completing the B-APQ. We created multivariable linear regression models to test for associations. Results: Factors independently associated with less positive perceptions about aging included white race, retired work status, having nonspecific comorbidities, and more catastrophic thinking. Variation in the magnitude of limitations and pain intensity was accounted for by effectiveness of coping strategies rather than attitudes toward aging in particular. A 4-question version of the B-APQ has acceptable performance. Conclusion: Adaptive attitudes toward aging are associated with psychological and social determinants of health. We present a 4-item short form of B-APQ that could be used as a brief measure to assess attitudes toward aging. Interventions to improve adaptiveness to nociception (eg, cognitive behavioral therapy to limit catastrophic thinking) might help with adaptation to age-related changes.
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Affiliation(s)
| | | | - Teun Teunis
- University Medical Center Utrecht, The Netherlands
| | - David Ring
- The University of Texas at Austin, USA,David Ring, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1701 Trinity Street, Austin, TX 78712, USA.
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15
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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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16
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Kortlever JTP, Tripathi S, Ring D, McDonald J, Smoot B, Laverty D. Tampa Scale for Kinesiophobia Short Form and Lower Extremity Specific Limitations. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:581-588. [PMID: 33088859 DOI: 10.22038/abjs.2020.40004.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We compared the amount of variation in Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) Computer Adaptive Test (CAT) accounted for by The Tampa Scale for Kinesiophobia (TSK) and its short form (TSK-4) independent of other factors. Questionnaire coverage, reliability, and validity were compared for both TSK and TSK-4 using mean scaled scores, internal consistency, floor and ceiling effects, interquestionnaire correlations, and collinearity with other measures as the Pain Catastrophizing Scale short form (PCS-4), PROMIS Depression CAT, and PROMIS Pain Interference (PROMIS PI) CAT. Methods One hundred forty eight consecutive new or return patients were enrolled. Patients were seen in an outpatient setting in several orthopaedic clinics in a large urban area. All patients completed the TSK, PROMIS PF CAT, PROMIS PI CAT, PROMIS Depression CAT, and PCS-4. Results Greater fear of movement (higher TSK) was associated with worse physical function (lower PROMIS PF CAT) and the full TSK explained more variation in physical function than the short form (TSK-4). In contrast to prior studies PCS-4 was not independent of TSK. Flooring and ceiling effects were seen with TSK-4. Worse physical function was associated with older age, traumatic condition, and more symptoms of depression. Conclusion The short form of the Tampa Scale for Kinesiophobia can be used as a brief screening measure in patient care and research in order to identify an independent influence of kinesiophobia on lower extremity specific limitations. Additional study is needed to determine whether there is utility in screening for both TSK and PCS or if one or the other provides sufficient information about cognitive biases regarding pain to guide treatment with cognitive behavioral therapy and related techniques.
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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, USA
| | - Shashwat Tripathi
- 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
| | - John McDonald
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
| | - Brannan Smoot
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
| | - David Laverty
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX, USA
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Depression and Somatization in Refractory Lateral Epicondylitis. Arch Rheumatol 2020; 34:367-370. [PMID: 32010884 DOI: 10.5606/archrheumatol.2019.7139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to present two major psychological factors, namely depression and somatization, which may occur with high probability in patients with refractory lateral epicondylitis (LE). Patients and methods This cross-sectional study included 36 patients (11 males, 25 females; mean age 42.6±8.09 years; range 26 to 60 years) diagnosed as refractory LE. Duration of symptoms was >6 months. Each patient completed the Beck Depression Inventory and the Symptom Checklist-90-Revised test evaluating psychosocial status and somatization, respectively. Results Depression was found in 24 (66.6%) (moderate in 15 [41.7%] and mild in 9 [25%]) and somatization was found in 28 (77.8%) patients. Depression and somatization were significantly more common in females than males (p=0.02 and p=0.04, respectively). Conclusion Depression and somatization may occur frequently in refractory LE patients, particularly in females. Both physical and psychological assessment tools should be incorporated into the clinical evaluation while psychological support should be included in the treatment of refractory LE.
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Blackburn J, Fischerauer SF, Talaei-Khoei M, Chen NC, Oh LS, Vranceanu AM. What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients? Clin Orthop Relat Res 2019; 477:2665-2673. [PMID: 31764332 PMCID: PMC6907317 DOI: 10.1097/corr.0000000000000888] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cyberchondria may be defined as heightened distress evoked through excessive searches of the internet for medical information. In healthy people, cyberchondria is associated with a greater intolerance of uncertainty and greater health anxiety. These relationships are likely bidirectional. People who have a greater intolerance of uncertainty may be more likely to search the internet for medical information and have greater health anxiety. This greater health anxiety may lead to an increased likelihood of engaging in further internet searches and greater intolerance of uncertainty. These three constructs are important for patients because they impact patient function and health care costs. We were specifically interested in understanding the role of cyberchondria in the association between intolerance of uncertainty and health anxiety among orthopaedic patients because it has not been explored before and because knowledge about these interactions could inform treatment recommendations. QUESTIONS/PURPOSES Does cyberchondria mediate (that is, explain) the association between intolerance of uncertainty and health anxiety in orthopaedic patients searching for medical information on the internet, after controlling for potentially confounding variables? METHODS This was a cross-sectional study of 104 patients who had searched the internet for any medical information about their current condition. A research assistant approached 155 patients attending two orthopaedic outpatient clinics, one hand and upper extremity service and one sports medicine clinic, during a 3-month period. Ten patients declined to participate and 41 patients were excluded, predominantly because they had never searched for medical information online. The patients completed the Cyberchondria Severity Scale, Intolerance of Uncertainty Scale-short version, Short Health Anxiety Inventory, and a numerical rating scale for pain intensity at baseline, as well as demographic and clinical questionnaires. We performed a series of linear regression analyses to determine whether a greater intolerance of uncertainty predicts greater cyberchondria (mediator) and whether cyberchondria predicts greater health anxiety. Although it is more appropriate to use the language of association (such as "whether cyberchondria is associated with health anxiety") in many observational studies, here, we opted to use the language of causation because this is the conventional language for studies testing statistical mediation. RESULTS After controlling for potentially confounding variables including pain intensity, multiple pain conditions, and education, cyberchondria explained 33% of the variance of the effect of intolerance of uncertainty on health anxiety (95% CI, 6.98 to 114.72%; p < 0.001). CONCLUSIONS Among orthopaedic patients who search the internet for medical information, a greater intolerance of uncertainty is associated with greater cyberchondria, which is associated with greater anxiety about health. Identifying patients with an intolerance of uncertainty and educating them about the negative role of compulsive searches for medical information may improve the success of orthopaedic treatment. Orthopaedic surgeons should also consider making referrals for cognitive behavioral therapy in these instances to increase the patient's tolerance of uncertainty, decrease internet searching habits, and reduce anxiety about health. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Julia Blackburn
- J. Blackburn, S.F. Fischerauer, M. Talaei-Khoei, N.C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA J. Blackburn, A-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA S.F. Fischerauer, Department of Orthopaedics and Traumatology, University Hospital Graz, Medical University of Graz, Graz, Austria L.S. Oh, Sports Medicine Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Objectives: To identify resources that patients perceive as helpful to their recovery and to characterize the impact of the Trauma Survivor Network (TSN), a program committed to enhancing recovery through education and engagement. Design: Prospective cohort study. Setting: Level 1 trauma center. Patients/Participants: Four hundred eighty-five patients with musculoskeletal injuries. Two hundred eleven were exposed to TSN resources (Group 1). One hundred thirty-five patients were treated during the same period with no exposure (Group 2, control). One hundred thirty-nine patients were treated 1 to 3 months prior to TSN implementation (Group 3, control). Intervention: TSN resources including educational materials, family classes, peer survivor visits, coaching, online services, and support groups. Main outcome measure: A survey to assess hospital experience and perceptions about recovery. Results: On a Likert scale from 0 to 5, patients were highly satisfied (mean 4.24), with no differences based on TSN exposure. Patients exposed to TSN programming reported greater perceived likelihood of recovery: mean 3.73 vs 3.41 vs 3.38, Group 1 vs Group 2 vs Group 3 (P = .05) and regarding return to daily activities: 3.69 vs 3.49 vs 3.10, P = .003. Fifty-three percent of Group 1 patients exposed to TSN programming utilized peer relationships and 42% read the educational materials provided. Support groups were also popular, with 26% of patients attending at least 1 session. Patients who recalled utilization of TSN services were overall highly satisfied with these services, mean 4.42. Conclusion: Patients were overall highly satisfied with their hospital stay, with those exposed to TSN services reporting greater perceived likelihood of recovery and return to daily activities. Development of nontraditional services, including peer visitation and support groups, appears to enhance expectations about recovery.
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MacDermid JC, Valdes K, Szekeres M, Naughton N, Algar L. The assessment of psychological factors on upper extremity disability: A scoping review. J Hand Ther 2019; 31:511-523. [PMID: 29198477 DOI: 10.1016/j.jht.2017.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/17/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The primary purpose of this scoping review was to describe the nature and extent of the published research that assesses the relationship between psychological features and patient-reported outcome following surgery or rehabilitation of upper extremity disease or injury. METHODS Twenty-two included studies were examined for quantitative study design, outcome measure, inclusion/exclusion criteria, follow-up and recruitment strategy. Patient population and psychological assessment tools were examined for validity. RESULTS Twenty-two studies met the inclusion criteria for this study. Only 7 of the 22 studies were longitudinal and the rest were cross sectional studies. Depression was the most common psychological status of interest and was included in 17 studies. Pain catastrophizing was the psychological status of interest in 5 of the studies. Four studies considered anxiety, 3 considered pain anxiety, 3 considered distress, 2 considered coping, 2 considered catastrophic thinking, and 2 considered fear avoidance beliefs. DISCUSSION The majority of studies in this review were cross-sectional studies. Cross-sectional studies may not provide conclusive information about cause-and-effect relationships. This review encourages clinicians to be mindful of the psychological implications found in rehabilitation of individuals with upper extremity disease or injury along with being cognizant of choosing appropriate measurement tools that best represent each patient's characteristics and diagnoses. CONCLUSIONS The nature of the research addressing psychological factors affecting outcomes after hand injury focus on negative traits and have limited strength to suggest causation as most have used cross-sectional designs. Stronger longitudinal designs and consideration of positive traits are needed in future studies.
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Affiliation(s)
- Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.
| | - Kristin Valdes
- Occupational Therapy Department, Gannon University, Ruskin, FL, USA
| | | | | | - Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
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Hamasaki T, Pelletier R, Bourbonnais D, Harris P, Choinière M. Pain-related psychological issues in hand therapy. J Hand Ther 2019; 31:215-226. [PMID: 29449064 DOI: 10.1016/j.jht.2017.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/16/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
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Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
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Araoye I, Pinter Z, Lee S, Netto CDC, Hudson P, Shah A. Revisiting the Prevalence of Associated Copathologies in Chronic Lateral Ankle Instability: Are There Any Predictors of Outcome? Foot Ankle Spec 2019; 12:311-315. [PMID: 30129378 DOI: 10.1177/1938640018793513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple ankle pathologies have been found to coexist with chronic lateral ankle ligament instability, but their prevalence varies widely in the literature. The purpose of this study is to reexamine the prevalence of these associated pathologies and to determine their impact on reoperation rate. METHODS We retrospectively reviewed 382 cases of lateral ankle ligament repair/reconstruction between June 2006 and November 2016. Patient charts and radiograph reports were examined for the presence of any associated foot and ankle pathologies as well as clinical course. The effect of copathologies on reoperation rate was examined using binary logistic regression and the χ2 test. RESULTS We included a total of 99 cases. Copathologies included peroneal pathology (75/99, 75.8%), ankle impingement (40/99, 40.4%), and osteochondral lesion of the talus (17/99, 17.2%); 36.4% (36/99) had a low-lying muscle belly of peroneus brevis. The total reoperation rate was 12/92 (13.1%). It was lower in cases with peroneal pathology (8.7% vs 27.5%, P = .032). CONCLUSION Peroneal pathology, ankle impingement, and osteochondral lesions were the most common associated copathologies in surgical patients with chronic lateral ankle ligament instability. The presence of peroneal pathology may lead to fewer reoperations, possibly as a result of a more comprehensive first-time surgical approach. Level of Evidence: Level III: Retrospective cohort.
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Affiliation(s)
| | | | - Sung Lee
- University of Alabama at Birmingham, Alabama
| | | | | | - Ashish Shah
- University of Alabama at Birmingham, Alabama
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Ottenhoff JSE, Derkzen L, Reichel LM, Vagner G, Loeb MD, Ring D. Satisfaction With Specific and Nonspecific Diagnoses. J Hand Surg Am 2019; 44:460-466.e1. [PMID: 30502015 DOI: 10.1016/j.jhsa.2018.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/31/2018] [Accepted: 10/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Nonspecific upper extremity illnesses (eg,. wrist pain, forearm pain)-where no objectively verifiable pathology is detectable-are common and usually self-limiting. For some patients, a nonspecific diagnosis can contribute to mistrust and disappointment. METHODS This study tested the primary null hypothesis that there is no difference in mean overall satisfaction between patients given a specific compared with a nonspecific diagnosis. Second, we assessed factors associated with satisfaction and with nonspecific upper extremity diagnosis. RESULTS There was no significant difference between mean satisfaction with nonspecific and specific diagnoses in bivariate analysis. However, when treated as a categorical variable, 22% of the patients with a nonspecific diagnosis had a satisfaction score of 8 or lower compared with 11% of the patients given a specific diagnosis. First visit and greater pain intensity were significantly associated with a nonspecific diagnosis in bivariate analysis. In the multivariable models, no factors were independently associated with satisfaction or with nonspecific diagnoses. CONCLUSIONS Although nonspecific diagnoses can sometimes be frustrating for both physician and patient, in this small study using a satisfaction measure with a strong ceiling effect, they were no less satisfying to patients on average and corresponded with slightly greater pain intensity than specific diagnoses. CLINICAL RELEVANCE The degree to which nonspecific diagnoses (perhaps in combination with compassionate care and incremental monitoring) can be part of a satisfying treatment experience merits additional investigation.
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Affiliation(s)
- Janna S E Ottenhoff
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Lindy Derkzen
- 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
| | - Gregg Vagner
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Michael D Loeb
- 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.
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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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Kortlever JTP, Keulen MHF, Teunis T, Ring D, Driscoll MD, Reichel LM, Vagner GA. Does resiliency mediate the association of psychological adaptability with disability and pain in patients with an upper extremity injury or illness? J Psychosom Res 2019; 117:1-9. [PMID: 30665589 DOI: 10.1016/j.jpsychores.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Symptom intensity and magnitude of limitations are highly variable for a given nociception and pathophysiology. As psychological determinants are of great influence to physical wellbeing, we assessed the influence of the protective factor measured and labelled as resilience in upper extremity illness. METHODS One hundred and six patients completed a survey of demographics, the Brief Resilience Scale (BRS), the Psychological Adaptation Scale (PAS), an 11-point ordinal measure of pain intensity, and the PROMIS Physical Function (PROMIS PF) Computer Adaptive Test (CAT). Measures of pain intensity and PROMIS PF were repeated 3 months later. We created mediation models using structural equation modeling (SEM) to assess the mediation effect of BRS on the association of PAS and other confounding variables with disability and pain at initial assessment and 3 months later. RESULTS Resiliency does not mediate the association of psychological adaptability with physical limitations and pain intensity at baseline (P = .89 and .82 respectively) or 3 months after enrollment (P = .65 and .72 respectively). CONCLUSIONS Positive and protective factors promote beneficial resilience mechanisms that strengthen coping responses to pain and disability. In future studies we should either include more patients to improve power and provide more information about the health benefits of resilience or focus more on mood and self-efficacy on symptoms and limitations in patients with musculoskeletal illness. LEVEL OF EVIDENCE Prospective, longitudinal cohort study; Level II.
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Affiliation(s)
- Joost T P Kortlever
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Mark H F Keulen
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Teun Teunis
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht; Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Matt D Driscoll
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Lee M Reichel
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
| | - Gregg A Vagner
- Department of Surgery and Perioperative Care, Dell Medical School - University of Texas at Austin, 1701 Trinity Street, 78712 Austin, TX, USA.
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Adverse Childhood Experiences Are Not Associated With Patient-reported Outcome Measures in Patients With Musculoskeletal Illness. Clin Orthop Relat Res 2019; 477:219-228. [PMID: 30586342 PMCID: PMC6345287 DOI: 10.1097/corr.0000000000000519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) affect adult mental health and tend to contribute to greater symptoms of depression and more frequent suicide attempts. Given the relationship between symptoms of depression and patient-reported outcomes (PROs), adversity in childhood might be associated with PROs in patients seeking care for musculoskeletal problems, but it is not clear whether in fact there is such an association among patients seeking care in an outpatient, upper extremity orthopaedic practice. QUESTIONS/PURPOSES (1) Are ACE scores independently associated with variation in physical limitations measured among patients seen by an orthopaedic surgeon? (2) Are ACE scores independently associated with variations in pain intensity? (3) What factors are associated with ACE scores when treated as a continuous variable or as a categorical variable? METHODS We prospectively enrolled 143 adult patients visiting one of seven participating orthopaedic surgeons at three private and one academic orthopaedic surgery offices in a large urban area. We recorded their demographics and measured ACEs (using a validated 10-item binary questionnaire that measured physical, emotional, and sexual abuse in the first 18 years of life), magnitude of physical limitations, pain intensity, symptoms of depression, catastrophic thinking, and health anxiety. There were 143 patients with a mean age of 51 years, 62 (43%) of whom were men. In addition, 112 (78%) presented with a specific diagnosis and most (n = 79 [55%]) had upper extremity symptoms. We created one logistic and three linear regression models to test whether age, gender, race, marital status, having children, level of education, work status, insurance type, comorbidities, body mass index, smoking, site of symptoms, type of diagnosis, symptoms of depression, catastrophic thinking, and health anxiety were independently associated with (1) the magnitude of limitations; (2) pain intensity; (3) ACE scores on the continuum; and (4) ACE scores categorized (< 3 or ≥ 3). We calculated a priori that to detect a medium effect size with 90% statistical power and α set at 0.05, a sample of 136 patients was needed for a regression with five predictors if ACEs would account for ≥ 5% of the variability in physical function, and our complete model would account for 15% of the overall variability. To account for 5% incomplete responses, we enrolled 143 patients. RESULTS We found no association between ACE scores and the magnitude of physical limitations measured by Patient-Reported Outcomes Measurement Information System Physical Function (p = 0.67; adjusted R = 0.55). ACE scores were not independently associated with pain intensity (Pearson correlation [r] = 0.11; p = 0.18). Greater ACE scores were independently associated with diagnosed mental comorbidities both when analyzed on the continuum (regression coefficient [β] = 1.1; 95% confidence interval [CI], 0.32-1.9; standard error [SE] 0.41; p = 0.006) and categorized (odds ratio [OR], 3.3; 95% CI, 1.2-9.2; SE 1.7; p = 0.024), but not with greater levels of health anxiety (OR, 1.1; 95% CI, 0.90-1.3; SE 0.096; p = 0.44, C statistic = 0.71), symptoms of depression (ACE < 3 mean ± SD = 0.73 ± 1.4; ACE ≥ 3 = 1.0 ± 1.4; p = 0.29) or catastrophic thinking (ACE < 3 = 3.6 ± 3.5; ACE ≥ 3 = 4.9 ± 5.1; p = 0.88). CONCLUSIONS ACEs may not contribute to greater pain intensity or magnitude of physical limitations unless they are accompanied by greater health anxiety or less effective coping strategies. Adverse events can contribute to anxiety and depression, but perhaps they sometimes lead to development of resilience and effective coping strategies. Future research might address whether ACEs affect symptoms and limitations in younger adult patients and patients with more severe musculoskeletal pathology such as major traumatic injuries. LEVEL OF EVIDENCE Level II, prognostic study.
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Abstract
BACKGROUND Psychologic factors are associated with pain and disability in patients with chronic shoulder pain. Recent research regarding the association of affective psychologic factors (emotions) with patients' pain and disability outcome after surgery disagrees; and the relationship between cognitive psychologic factors (thoughts and beliefs) and outcome after surgery is unknown. QUESTIONS/PURPOSES (1) Are there identifiable clusters (based on psychologic functioning measures) in patients undergoing shoulder surgery? (2) Is poorer psychologic functioning associated with worse outcome (American Shoulder and Elbow Surgeons [ASES] score) after shoulder surgery? METHODS This prospective cohort study investigated patients undergoing shoulder surgery for rotator cuff-related shoulder pain or rotator cuff tear by one of six surgeons between January 2014 and July 2015. Inclusion criteria were patients undergoing surgery for rotator cuff repair with or without subacromial decompression and arthroscopic subacromial decompression only. Of 153 patients who were recruited and consented to participate in the study, 16 withdrew before data collection, leaving 137 who underwent surgery and were included in analyses. Of these, 124 (46 of 124 [37%] female; median age, 54 years [range, 21-79 years]) had a complete set of four psychologic measures before surgery: Depression, Anxiety and Stress Scale; Pain Catastrophizing Scale; Pain Self-Efficacy Questionnaire; and Tampa Scale for Kinesiophobia. The existence of clusters of people with different profiles of affective and cognitive factors was investigated using latent class analysis, which grouped people according to their pattern of scores on the four psychologic measures. Resultant clusters were profiled on potential confounding variables. The ASES score was measured before surgery and 3 and 12 months after surgery. Linear mixed models assessed the association between psychologic cluster membership before surgery and trajectories of ASES score over time adjusting for potential confounding variables. RESULTS Two clusters were identified: one cluster (84 of 124 [68%]) had lower scores indicating better psychologic functioning and a second cluster (40 of 124 [32%]) had higher scores indicating poorer psychologic functioning. Accounting for all variables, the cluster with poorer psychologic functioning was found to be independently associated with worse ASES score at all time points (regression coefficient for ASES: before surgery -9 [95% confidence interval {CI}, -16 to -2], p = 0.011); 3 months after surgery -15 [95% CI, -23 to -8], p < 0.001); and 12 months after surgery -9 [95% CI, -17 to -1], p = 0.023). However, both clusters showed improvement in ASES score from before to 12 months after surgery, and there was no difference in the amount of improvement between clusters (regression coefficient for ASES: cluster with poorer psychologic function 31 [95% CI, 26-36], p < 0.001); cluster with better psychologic function 31 [95% CI, 23-39], p < 0.001). CONCLUSIONS Patients who scored poorly on a range of psychologic measures before shoulder surgery displayed worse ASES scores at 3 and 12 months after surgery. Screening of psychologic factors before surgery is recommended to identify patients with poor psychologic function. Such patients may warrant additional behavioral or psychologic management before proceeding to surgery. However, further research is needed to determine the optimal management for patients with poorer psychologic function to improve pain and disability levels before and after surgery. LEVEL OF EVIDENCE Level II, therapeutic study.
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Shin YH, Yoon JO, Kim YK, Kim JK. Psychological Status Is Associated With Symptom Severity in Patients With Carpal Tunnel Syndrome. J Hand Surg Am 2018; 43:484.e1-484.e8. [PMID: 29305236 DOI: 10.1016/j.jhsa.2017.10.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/29/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate whether psychological status is associated with symptom severity or functional disability of carpal tunnel syndrome (CTS) patients. PATIENTS AND METHODS Sixty patients diagnosed with CTS and treated with carpal tunnel release (CTR) were asked to complete a self-administered questionnaire consisting of 3 validated measures obtained before and 3 months after surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to assess symptoms (BCTQ-S) and functional disabilities (BCTQ-F), and the Center for Epidemiologic Studies Depression Scale (CES-D) and Pain Anxiety Symptoms Scale (PASS) were administered to assess depression and pain anxiety. The preoperative scores and those obtained 3 months after CTR were compared. Bivariate and multivariable regression analyses were performed to determine whether the variance of CES-D and PASS scores are associated with the variance of symptom severity or functional disability of CTS patients. RESULTS The CES-D and PASS scores significantly improved after surgery. In a multivariable linear regression model, the CES-D and PASS scores were significantly associated with the BCTQ-S scores both before and 3 months after surgery. In addition, the changes in CES-D and PASS scores were significantly associated with the change in BCTQ-S scores. CONCLUSIONS The depression level and pain anxiety of CTS patients were significantly improved at 3 months after CTR. The depression level and pain anxiety were significantly associated with the CTS symptoms in both the preoperative and the postoperative period. In addition, the improvement of depression and pain anxiety were associated with the improvement of CTS symptoms. Thus, our findings indicate that the depression and pain anxiety of CTS patients are associated with the symptom severity of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun O Yoon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You Keun Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Kelly JD. CORR Insights®: Does a Brief Mindfulness Exercise Improve Outcomes in Upper Extremity Patients? A Randomized Controlled Trial. Clin Orthop Relat Res 2018; 476:799-800. [PMID: 29406459 PMCID: PMC6260072 DOI: 10.1007/s11999.0000000000000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- John D Kelly
- J. D. Kelly IV, Professor of Clinical Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Gundes H, Selek Ö, Gok U, Gumuslu B, Buluc L. The relation between elbow range of motion and patient satisfaction after open release of stiff elbow. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017. [PMID: 28645832 PMCID: PMC6197447 DOI: 10.1016/j.aott.2017.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The aim of this retrospective study was to find out whether a cut off value existed for elbow flexion and extension after open surgical release of elbow contracture that would correlate with subjective patient satisfaction. Methods The study enrolled 77 patients (53 males and 24 females with a mean age of 35.1 (18–77) years at the time of operation) with elbow contracture who attended regular follow-up appointments for more than 12 months. The mean follow up period was 44.2 months (12–186). The preoperative and postoperative modified MAYO elbow scores, objective parameters of increase in both flexion and extension end point measurements and improvement in total ROM were compared in order to determine the cut off degree of ROM in both flexion and extension that significantly correlated with patient satisfaction. Results Of the 77 participating patients, 26 patients had an extrinsic (33.8%) and 51 patients had an intrinsic elbow contracture (66.2%). Surgeries performed involved 40 cases of lateral release and 37 cases of both lateral and medial (progressive) release. The median preoperative total flexion-extension arch (ROM) was 45° (20°–65°). The median postoperative total flexion-extension arch (ROM) was 110° (97.5°–125°). The modified MAYO elbow score improved from 60 to 85 points postoperatively. The postoperative flexion cut off value was 115° for an excellent or good postoperative modified MAYO elbow score. Conclusion Post-operative flexion cut off value was 115° and had a positive effect on the postoperative patient satisfaction. The cut off value for postoperative extension was 20° but it was not a significant variable on patient satisfaction as was the total increase in ROM. Level of significance Level IV Therapeutic Study.
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Affiliation(s)
| | | | - Umit Gok
- Kocaeli University, Kocaeli, Turkey
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Park JW, Gong HS, Rhee SH, Kim J, Lee YH, Baek GH. The Effect of Psychological Factors on the Outcomes of Carpal Tunnel Release: A Systematic Review. J Hand Surg Asian Pac Vol 2017; 22:131-137. [DOI: 10.1142/s0218810417300029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Several studies report that psychological factors are associated with outcomes of carpal tunnel release. However, interpretation of the association is difficult as there are diverse outcome parameters and patient expectations are different. We performed a systematic review to assess the relationships between psychological factors and the various outcome parameters. Methods: We identified 611 papers and selected 8 papers that fit the inclusion criteria. Psychological factors assessed were anxiety, depression, pain catastrophizing, coping, and mental health status. Outcomes of interest included satisfaction and measures of perceived level of function, pain, and physical measures of recovery. Results: For satisfaction and perceived level of function as the outcome, three studies reported a significant association, one study found an association approaching a value of significance, and one study reported no association. For pain as the outcome, two studies reported a significant association. For physical measures, one study reported no association. Conclusions: This systematic review found that depression correlates with postoperative pain, but that the association is less clear between psychological factors and outcomes such as satisfaction, perceived level of symptom and function, and physical measures of recovery. As pain may not be a primary symptom or outcome of CTS, we consider that the current literature does not strongly support the association between psychological factors and outcomes of CTR. This review could be of benefit during preoperative counseling in patients with psychological disturbances.
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Affiliation(s)
- Jin Woo Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Hwan Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihyeung Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Does electrodiagnostic evidence correlate with mood and function in patients with a pre-diagnosis of carpal tunnel syndrome? Turk J Phys Med Rehabil 2017; 63:335-339. [PMID: 31453476 DOI: 10.5606/tftrd.2017.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/07/2016] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate if function and mood involvement correlate in female patients who have a pre-diagnosis of carpal tunnel syndrome (CTS) and its correlation with physical examination and electrodiagnostic findings. Patients and methods A total of 170 patients between the ages of 18-65 who applied to Physical Medicine and Rehabilitation outpatient clinics with CTS symptoms between May 2014 and December 2015 were enrolled. The mean age of patients was 44.6±11 years. Before electrophysiological testing (electromyography; EMG), Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), Beck Depression Inventory, Tinnel, Phalen and Durkan tests, grip and pinch strength measurement by JAMAR hand dynamometer were performed. The patients also used a Visual Analog Scale (VAS) to determine the severity of their symptoms during the day and at night. Results In 98 patients (57.6%) the diagnosis of CTS was confirmed by EMG, while 72 patients (42.4%) had normal electrodiagnostic findings. In patients who had normal EMG, Beck Depression Inventory and QuickDASH scores were not significantly different from the patients who had an electrodiagnosis of CTS. Pain experienced in the night was significantly higher in patients who had an electrodiagnosis of CTS, and these patients had significantly higher Beck Depression Inventory and QuickDASH scores. Conclusion The lack of electrodiagnostic evidence in patients who have CTS symptoms does not show that function and mood are not affected in these patients. However, mood is significantly affected in patients with severe CTS.
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Teunis T, Thornton ER, Guitton TG, Vranceanu AM, Ring D. Coaching of patients with an isolated minimally displaced fracture of the radial head immediately increases range of motion. J Hand Ther 2017; 29:314-9. [PMID: 27496986 DOI: 10.1016/j.jht.2016.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 11/27/2015] [Accepted: 02/09/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort. INTRODUCTION Elbow stiffness is the most common adverse event after isolated radial head fractures. PURPOSE OF THE STUDY To assess the effect of coaching on elbow motion during the same office visit in patients with such fractures. METHODS We enrolled 49 adult patients with minimally displaced radial head fractures, within 14 days of injury. After diagnosis, we measured demographics, catastrophic thinking, health anxiety, symptoms of depression, upper extremity-specific symptoms and disability, pain, and elbow and wrist motion. The patient was taught to apply an effective stretch in spite of the pain to limit stiffness, and elbow motion was measured again. RESULTS With the exception of radial deviation and pronation, motion measures improved slightly but significantly on average immediately after coaching. Elbow flexion improved from 79% (110° ± 22°) of the uninjured side to 88% (122° ± 18°) after coaching (P < .001); elbow extension improved from 71% (29° ± 14°) to 78% (22° ± 15°) (P = .0012). DISCUSSION Instruction that stretching exercises are healthy even when painful resulted in immediate improvements in motion. Prospective studies comparing different strategies for coaching patients regarding painful stretches might help clarify the optimal approach. LEVEL OF EVIDENCE Therapeutic level 4.
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Affiliation(s)
- Teun Teunis
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily R Thornton
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thierry G Guitton
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Oh Y, Drijkoningen T, Menendez ME, Claessen FMAP, Ring D. The Influence of Psychological Factors on the Michigan Hand Questionnaire. Hand (N Y) 2017; 12:197-201. [PMID: 28344534 PMCID: PMC5349404 DOI: 10.1177/1558944716642765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital-based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.
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Affiliation(s)
- Yekyoo Oh
- Harvard Medical School, Boston, MA, USA
| | | | | | | | - David Ring
- Harvard Medical School, Boston, MA, USA,David Ring, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey Center, Suite 2100, Boston, MA 02114, USA.
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Briet JP, Houwert RM, Hageman MGJS, Hietbrink F, Ring DC, Verleisdonk EJJM. Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury 2016; 47:2565-2569. [PMID: 27659849 DOI: 10.1016/j.injury.2016.09.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/07/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Swelling, tenderness, and ecchymosis don't correlate with time to functional recovery in patients with a lateral ankle sprain. It is established that psychosocial factors such as symptoms of depression and low pain self-efficacy correlate with pain intensity and magnitude of limitations in patients with musculoskeletal disorders. OBJECTIVE We studied the correlation between pain self-efficacy or symptoms of depression and (1) ankle specific limitations and (2) pain intensity in patients with a lateral ankle sprain. Further we explored the correlation between estimation of sprain severity (grade) and (3) pain intensity or magnitude of ankle specific limitations. DESIGN Eighty-four patients with a lateral ankle sprain prospectively completed the Pain Self Efficacy Questionnaire, the Olerud Molander Ankle Score, Ordinal scale of Pain and the Patient Health Questionnaire-2 at enrollment and the Olerud Molander Ankle Score and the Ordinal scale of Pain three weeks after the injury. Factors associated with higher ankle specific limitations and symptoms were investigated in bivariable and multivariable analysis. RESULTS When accounting for confounding factors, greater self-efficacy (p=0.01) and older age (p<0.01) were significantly associated with greater ankle specific symptoms and limitations three weeks after the injury and explained 22% of the variability in ankle specific limitations and symptoms. There was no correlation between the grade of the sprain and pain intensity or ankle specific limitations or symptoms. CONCLUSIONS Psychosocial factors (adaptiveness in response to pain in particular) explain more of the variation in symptoms and limitations after ankle sprain than the degree of pathophysiology. The influence of adaptive illness descriptions and recovery strategies based on methods for improving self-efficacy (i.e. cognitive behavioral therapy) might enhance and speed recovery from ankle injuries and merit additional investigation. LEVEL OF EVIDENCE Level 2 prospective cohort study.
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Affiliation(s)
- Jan Paul Briet
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582KE, Utrecht, The Netherlands.
| | | | - Michiel G J S Hageman
- Department of Orthopaedic surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States
| | - Falco Hietbrink
- Department of Surgery UMC Utrecht, Heidelberglaan 100, PO 85500, 3508 GA Utrecht, The Netherlands
| | - David C Ring
- Department of Surgery and Perioperative Care, New Dell Medical Center, Austin, TX, United States
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Shank TM, Harron W. A retrospective outcomes study examining the effect of interactive metronome on hand function. J Hand Ther 2016; 28:396-401; quiz 402. [PMID: 26521143 DOI: 10.1016/j.jht.2015.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 05/28/2015] [Accepted: 06/30/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Interactive Metronome (IM, The Interactive Metronome Company, Sunrise, Florida, USA) is a computer-based modality marketed to rehabilitation professionals who want to improve outcomes in areas of coordination, motor skills, self-regulation behaviors, and cognitive skills. PURPOSE This retrospective study examined the efficacy of IM training on improving timing skills, hand function, and parental report of self-regulatory behaviors. METHODS Forty eight children with mixed motor and cognitive diagnoses completed an average of 14 one-hour training sessions over an average of 8.5 weeks in an outpatient setting. Each child was assessed before and after training with the Interactive Metronome Long Form Assessment, the Jebsen Taylor Test of Hand Function, and a parent questionnaire. RESULTS All three measures improved with statistical significance despite participants having no direct skill training. CONCLUSION These results suggest an intimate relationship between cognition and motor skills that has potential therapeutic value. LEVEL OF EVIDENCE Level 4, Retrospective Case Series.
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Affiliation(s)
- Tracy M Shank
- Outpatient Therapy Services, Nemours / A. I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA.
| | - Wendy Harron
- Outpatient Therapy Services, Nemours / A. I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 USA
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Nota SPFT, Spit SA, Oosterhoff TCH, Hageman MGJS, Ring DC, Vranceanu AM. Is Social Support Associated With Upper Extremity Disability? Clin Orthop Relat Res 2016; 474:1830-6. [PMID: 27172821 PMCID: PMC4925422 DOI: 10.1007/s11999-016-4892-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/06/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain intensity and disability correlate with psychosocial factors such as depression and pain interference (the degree to which pain interferes with activities of daily living) as much or more than pathophysiology in upper extremity illness. However, other factors like emotional support (perception of being cared for and valued as a person), instrumental support (perception of availability of tangible assistance when needed), positive psychosocial impact (perception and focus on the positive side of a difficult situation, sometimes characterized as posttraumatic growth, benefit-finding, or meaning making), also might be associated with disability in patients with upper extremity orthopaedic illness. This is the first published study, to our knowledge, addressing the potential association of emotional support, instrumental support, and positive psychosocial illness impact with disability in patients with upper extremity illness. QUESTIONS/PURPOSES We asked: (1) Is there a correlation between the QuickDASH and the Patient-reported Outcomes Measurement Information System (PROMIS(®)) emotional support Computer Adaptive Testing (CAT)? (2) Is there a correlation between the QuickDASH and PROMIS(®) instrumental support CAT? (3) Is there a correlation between the QuickDASH and PROMIS(®) positive psychosocial illness impact CAT? (4) Among the PROMIS(®) measures of depression, emotional support, instrumental support, positive illness impact, and pain interference, which accounts for the most variance in QuickDASH scores? METHODS One hundred ninety-three patients with upper extremity illness (55% women; average age, 51 ± 18 years) of 213 approached (91% recruitment rate) completed the QuickDASH, and five different PROMIS(®) CATs: pain interference (the degree to which pain interferes with accomplishing one's goals), depression, emotional support, psychosocial illness impact, and instrumental support. We recruited patients from the practice of three surgeons in hand service of the department of orthopaedic surgery at a major urban university hospital. RESULTS Pearson Product Moment Correlations showed that emotional support (r = -0.18; p = 0.014) and instrumental support (r = -0.19; p = 0.008) were weakly and inversely associated with the QuickDASH), while positive psychosocial illness impact was moderately and inversely associated with the QuickDASH (r = -0.36; p < 0.001). In multivariable analyses, pain interference, but not the social support measures, was the only psychosocial factor associated with the QuickDASH and alone explained 66% of variance. CONCLUSIONS Emotional support, instrumental support and positive psychosocial illness impact are all individually associated with disability to a small degree, but pain interference (the degree to which pain interferes with accomplishing one's goals) has the strongest influence on magnitude of disability. LEVEL OF EVIDENCE Level 1, prognostic study.
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Affiliation(s)
- Sjoerd P. F. T. Nota
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA
| | - Silke A. Spit
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA
| | - Thijs C. H. Oosterhoff
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA
| | | | - David C. Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA ,Department of Surgery and Perioperative Care, Dell Medical School, 1400 Barbara Jordan Blvd., Suite 2.834; MC: R1800, Austin, TX 78723 USA
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van Leeuwen WF, van der Vliet QMJ, Janssen SJ, Heng M, Ring D, Vranceanu AM. Does perceived injustice correlate with pain intensity and disability in orthopaedic trauma patients? Injury 2016; 47:1212-6. [PMID: 26994517 DOI: 10.1016/j.injury.2016.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Individuals who experience musculoskeletal trauma may construe the experience as unjust and themselves as victims. Perceived injustice is a cognitive construct comprised by negative appraisals of the severity of loss as a consequence of injury, blame, injury-related loss, and unfairness. It has been associated with worse physical and psychological outcomes in the context of chronic health conditions. The purpose of this study is to explore the association of perceived injustice to pain intensity and physical function in patients with orthopaedic trauma. METHODS A total of 124 orthopaedic trauma patients completed the Injustice Experience Questionnaire (IEQ), the PROMIS Physical Function Computer Adaptive Testing (CAT), the PROMIS Pain Intensity instruments, the short form Patient Health Questionnaire for depression (PHQ-2), the short form Pain Self-Efficacy Questionnaire (PSEQ-2), and the short form Pain Catastrophizing Scale (PCS-4) on a tablet computer. A stepwise linear regression model was used to identify the best combination of predictors explaining variance in PROMIS Physical Function and PROMIS Pain Intensity. RESULTS The IEQ was associated with PROMIS Physical Function (r=-0.36; P<0.001) and PROMIS Pain Intensity (r=0.43; P<0.001). In multivariable analysis, however, Caucasian race (β=5.1, SE: 2.0, P=0.013, 95% CI: 1.1-9.2), employed work status (β=5.1, SE: 1.5, P=0.001, 95% CI: 2.1-8.2), any cause of injury other than sports, mvc, or fall (β=7.7, SE: 2.1, P<0.001, 95% CI: 3.5-12), and higher self-efficacy (PSEQ-2; β=0.93, SE: 0.23, P<0.001, 95% CI: 0.48-1.4) were selected as part of the best model predicting variance in PROMIS Physical Function. Only a higher degree of catastrophic thinking (PCS-4; β=1.2, SE: 0.12, P<0.001, 95% CI: 0.99 to 1.5) was selected as important in predicting higher PROMIS Pain Intensity. CONCLUSION Perceived injustice was associated with both physical function and pain intensity in bivariate correlations, but was not deemed as an important predictor when assessed along with other demographic and psychosocial variables in multivariable analysis. This study confirms prior research on the pivotal role of catastrophic thinking and self-efficacy in reports of pain intensity and physical function in patients with acute traumatic musculoskeletal pain.
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Affiliation(s)
- Wouter F van Leeuwen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America.
| | - Quirine M J van der Vliet
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America.
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, United States of America.
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Massachusetts General Hospital, Harvard Medical School, United States of America.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, United States of America.
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, United States of America.
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One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress. Clin Orthop Relat Res 2015; 473:3501-10. [PMID: 26293222 PMCID: PMC4586226 DOI: 10.1007/s11999-015-4513-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function. In several other areas of orthopaedics, higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery. To our knowledge, the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated. QUESTIONS/PURPOSES (1) Are higher levels of preoperative psychological distress associated with differences in outcome scores (visual analog scale [VAS] for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (2) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores (VAS for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (3) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair? METHODS Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled; 70 patients (82%) were assessed at 1-year followup. During the study period, the three participating surgeons performed 269 rotator cuff repairs; in large part, the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire, and patients completed self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair. Fifty of 85 patients (59%) had normal levels of distress, 26 of 85 (31%) had moderate levels of distress, and nine of 85 (11%) had severe levels of distress. Statistical models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function at 1 year after surgery. RESULTS With the numbers available, distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain (1.9 [95% confidence interval {CI}, 1.0-2.8] versus 1.0 [95% CI, 0.5-1.4], p = 0.10), Simple Shoulder Test (9 [95% CI, 8.1-10.4] versus 11 [95% CI, 10.0-11.0], p = 0.06), or American Shoulder and Elbow Surgeons scores (80 [95% CI, 72-88] versus 88 [95% CI, 84-92], p = 0.08) 1 year after arthroscopic rotator cuff repair. With the numbers available, distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain (3 [95% CI, 2.2-4.1] versus 2 [95% CI, 1.4-2.9], p = 0.10), Simple Shoulder Test (5.2 [95% CI, 3.7-6.6] versus 5.0 [95% CI, 4.2-5.8], p = 0.86), or American Shoulder and Elbow Surgeons scale (38 [95% CI, 29-47] versus 30 [95% CI, 25-36], p = 0.16). The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 (20%) versus 35 of 85 (41%) preoperatively (odds ratio, 0.36; 95% CI, 0.17-0.74; p = 0.005). CONCLUSIONS Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinically important degree in this small series of patients with rotator cuff tears. This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status. LEVEL OF EVIDENCE Level I, prognostic study.
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Kortlever JTP, Janssen SJ, van Berckel MMG, Ring D, Vranceanu AM. What Is the Most Useful Questionnaire for Measurement of Coping Strategies in Response to Nociception? Clin Orthop Relat Res 2015; 473:3511-8. [PMID: 26105152 PMCID: PMC4586216 DOI: 10.1007/s11999-015-4419-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are several measures of coping strategies in response to nociception. These measures all correlate highly both with each other and with symptom intensity and magnitude of disability in patients with upper limb illness. This study aims to determine if distinct measures of coping strategies in response to nociception address the same underlying aspect of human illness behavior. QUESTIONS/PURPOSES Our primary study question was: is there one common aspect of human illness behavior measured by (1) the Pain Catastrophizing Scale (PCS); (2) the Psychological Inflexibility in Pain Scale (PIPS); (3) the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Computer Adaptive Test (CAT); and (4) the Pain Self-Efficacy Questionnaire (PSEQ)? Secondarily, we aimed to determine which of the four questionnaires is most psychometrically sound. We measured correlations among questionnaires, coverage, reliability, completion time, and collinearity of these questionnaires when entered together in a multivariable model with the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) upper extremity disability questionnaire. METHODS In this prospective study, 138 consecutive new or followup English-speaking patients aged 18 years or older presenting to a tertiary care referral center with traumatic and nontraumatic upper extremity conditions were invited to participate between March and May 2014. One hundred thirty-four (97%) patients agreed to participate and completed the four questionnaires in random order before their visit with the physician. We used exploratory factor analysis to assess whether there was a single common trait-an underlying aspect of human illness behavior-measured by these questionnaires. Interquestionnaire correlation was assessed using Spearman rank correlation coefficients; coverage by assessing floor and ceiling effect (proportion of scores at lower and upper limit); reliability by Cronbach's alpha measure of internal consistency; completion time in seconds using Kruskal-Wallis analysis; and collinearity statistics through a regression model with QuickDASH. RESULTS Exploratory factor analysis identified a common trait measured by these four measures-coping strategies in response to nociception-indicated by a substantial correlation of every individual questionnaire with the underlying trait (PCS: 0.74, PIPS: 0.84, PROMIS-PI: 0.83, PSEQ: -0.86). All interquestionnaire correlations were also large to substantial and were highest for PROMIS-PI with PSEQ (rho = -0.84, p < 0.001) and lowest for PROMIS-PI with PCS (rho = 0.67, p < 0.001). Internal consistencies were high (PCS: 0.93, PIPS: 0.88, PSEQ: 0.92, and not determined for the PROMIS-PI as a result of its CAT administration). PROMIS-PI was the quickest to complete (30 seconds [interquartile range, 24-44]) compared with the others (PCS: 91 seconds [66-122], p < 0.001; PIPS: 105 seconds [82-141], p < 0.001; PSEQ: 78 seconds [60-101], p < 0.001). The four coping questionnaires had a low partial r(2) and a relatively high variation inflation factor, indicating multicollinearity. PROMIS-PI was found to have the strongest correlation with QuickDASH (β coefficient: 0.63; standard error: 0.10; p < 0.001). CONCLUSIONS There is evidence that the four widely used measures of coping strategies in response to nociception address a single common aspect of human illness behavior, which negatively impacts upper extremity disability. Future studies assessing functional outcome should incorporate a measure of human illness behavior as it strongly relates to disability. CLINICAL RELEVANCE Given that all of these measures address the same important aspect of human illness behavior, we recommend the PROMIS-PI CAT as the most efficient measure.
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Affiliation(s)
- Joost T. P. Kortlever
- />Department of Orthopaedic Surgery, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Stein J. Janssen
- />Department of Orthopaedic Surgery, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Marijn M. G. van Berckel
- />Department of Orthopaedic Surgery, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - David Ring
- />Department of Orthopaedic Surgery, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ana Maria Vranceanu
- />Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 7th Floor, Boston, MA 02114 USA
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Menendez ME, Ring D, Bateman BT. Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery. Clin Orthop Relat Res 2015; 473:2402-12. [PMID: 25694266 PMCID: PMC4457771 DOI: 10.1007/s11999-015-4173-5] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/27/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. QUESTIONS/PURPOSES We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use. METHODS We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002-2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use. RESULTS The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p < 0.001). Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR], 3.7; 95% CI, 2.7-5.1) and aggregate morbidity (OR, 2.3 l; 95% CI, 2.2-2.4), including induced mental disorder (OR, 5.9; 95% CI, 5.4-6.3), respiratory failure (OR, 3.1; 95% CI, 2.7-3.6), surgical site infection (OR, 2.5; 95% CI, 2.0-3.0), mechanical ventilation (OR, 2.3; 95% CI, 2.0-2.5), pneumonia (OR, 2.1; 95% CI, 1.8-2.3), myocardial infarction (OR, 1.9; 95% CI, 1.3-2.6), and postoperative ileus or other gastrointestinal events (OR, 1.4; 95% CI, 1.3-1.6) (p < 0.001 for all listed entities). Abuse and dependence also were associated with increased risk for prolonged hospital length of stay (OR, 2.5; 95% CI, 2.4-2.5), nonroutine discharge (OR, 2.2; 95% CI, 2.2-2.3), and failure to rescue (OR, 2.0; 95% CI, 1.4-2.8). High-risk opioid users were more likely to be younger, male, nonwhite, Medicaid-insured patients with mental health and substance use disorders, and to be undergoing spine surgery. Hospital-related characteristics included urban setting, geographic location in the Northeast or West, and serving as a teaching facility. CONCLUSION Opioid abuse and dependence are increasing rapidly among orthopaedic surgical inpatients and are associated with considerable postoperative morbidity and mortality and resource utilization. We recommend that orthopaedic surgeons screen patients carefully for opioid misuse preoperatively, help patients who are using opioids inappropriately to discontinue them before scheduling elective surgery, decline to perform elective surgery in patients who misuse opioids, and closely monitor patients who are habituated to opioids at the time they undergo surgery. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Mariano E. Menendez
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Boston, MA 02114 USA ,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Suite 2100, Boston, MA 02114 USA ,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Brian T. Bateman
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA USA ,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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Hung M, Bounsanga J, Tang P, Chen W, Cheng C. The factor structure of the hospital anxiety and depression scale in orthopedic trauma patients. J Clin Med Res 2015; 7:453-9. [PMID: 25883709 PMCID: PMC4394919 DOI: 10.14740/jocmr2140w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 11/11/2022] Open
Abstract
Background Many instruments exist to assess mental disorders and anxiety, such as the hospital anxiety and depression scale (HADS). Nothing has been evaluated on the HADS factor structure for use with orthopedic trauma patients. The aim of this study was to validate the underlying structure of the HADS. Specifically, we sought to understand which of the factor structures found in the literature is appropriate for the orthopedic trauma patient population. Methods This study included 348 patients with an average age of 49.8 years (SD: 18.4; range: 18 - 95). Confirmatory data analysis was performed to analyze the latent structure of the HADS. Akaike information criterion (AIC) was used to compare all the models, with the lowest AIC being the best fitting model. Results We found that both the anxiety and the depression factors were highly correlated (with Pearson correlations greater than 0.700). After removing one item from each subscale, we found that a two-factor model was the best fitting one (AIC: 8,298.901); all other models had an AIC over 10,000. Conclusion Our results support a satisfactory two-factor structure for the HADS in the orthopedic trauma patients. Further studies are needed to test for higher factor structures in larger samples and in a different population.
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Affiliation(s)
- Man Hung
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Jerry Bounsanga
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Philip Tang
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Wei Chen
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Christine Cheng
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
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Strooker JA, Nota SPFT, Hageman MGJS, Ring DC. Patients with greater symptom intensity and more disability are more likely to be surprised by a hand surgeon's advice. Clin Orthop Relat Res 2015; 473:1478-83. [PMID: 25280552 PMCID: PMC4353519 DOI: 10.1007/s11999-014-3971-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND A clash between a patient's assumptions and a doctor's advice can feel adversarial which might influence satisfaction ratings and compliance with treatment recommendations. A better understanding of sources of patients' bewilderment might lead to improved strategies for conveying counterintuitive information that improve patient comfort and wellbeing. QUESTIONS/PURPOSES This study addressed the following questions: (1) Are magnitude of disability, pain intensity, symptoms of depression, or health anxiety associated with a higher level of surprise when a patient is presented with diagnostic information and/or therapeutic recommendations? (2) Does the surgeon accurately perceive the patient's bewilderment? (3) Does the surgeon's perception of patient bewilderment correlate with diagnosis or a patient's magnitude of disability, pain intensity, symptoms of depression, or health anxiety? PATIENTS AND METHODS In this prospective cohort study, we invited new patients who met prespecified criteria during a 3-month period in one hand-surgery practice to enroll; of 93 patients invited, 84 (90%) agreed to participate. Patients reported demographics and completed the short versions of the DASH questionnaire (QuickDASH), the Patient Health Questionnaire, the Pain Self-Efficacy Questionnaire, and the Short Health Anxiety Inventory; rated their pain intensity; and rated the degree to which the information given by the surgeon was unexpected or surprising on an 11-point ordinal scale. The surgeon also rated his impression of the patient's surprise on an 11-point ordinal scale. RESULTS Only greater symptom intensity and magnitude of disability (QuickDASH) correlated with greater unexpected information when rated by the patient (ß = 0.058; p < 0.001). There was a correlation between patient surprise and the surgeon's perception of the patient's surprise (r = 0.58; p < 0.001). Greater surgeon-perceived patient surprise correlated with nonspecific illness (p = 0.007; ß = 3.0). CONCLUSIONS Patients with greater symptom intensity and magnitude of disability, and perhaps also patients with nonspecific diagnoses, are more likely to be surprised by a hand surgeon's advice. Future research might address the ability of previsit preparation (using decision aids or other alternative means of education) to ameliorate the discordance between patient assumptions and hand surgeon advice.
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Affiliation(s)
- Joost A. Strooker
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Sjoerd P. F. T. Nota
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - Michiel G. J. S. Hageman
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | - David C. Ring
- Hand Surgery Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Nota SPFT, Bot AGJ, Ring D, Kloen P. Disability and depression after orthopaedic trauma. Injury 2015; 46:207-12. [PMID: 25015790 DOI: 10.1016/j.injury.2014.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/28/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Musculoskeletal injury is a common cause of impairment (pathophysiology), but the correlation of impairment with pain intensity and magnitude of disability is limited. Psychosocial factors explain a large proportion of the variance in disability for various orthopaedic pathologies. The aim of this study is to prospectively assess the relationship between psychological factors and magnitude of disability in a sample of orthopaedic trauma patients in The Netherlands. MATERIAL AND METHODS One hundred and one adult patients between 1 and 2 months after one or more fractures, tendon or ligament injuries were enrolled. Four eligible patients refused to participate. Thirty-five women and 30 men with an average age of 50 years (range, 22-92 years) completed the follow-up evaluation between 5 and 8 months after their injury and their data was analyzed. The patients completed a measure of disability (the Short Musculoskeletal Function Assessment-Netherlands, SMFA-NL), the Dutch Centre for Epidemiologic Study of Depression-scale (CES-D), the Dutch Impact of Event Scale (SVL), and the Dutch Pain Catastrophizing Scale (PCS) at the time of enrollment and again 5-8 months after injury. RESULTS There were moderate correlations between symptoms of depression (CES-D, r=0.48, p<0.001) and symptoms of PTSD (SVL, r=0.35, p=0.004) at enrollment and magnitude of disability 5-8 months after trauma. Catastrophic thinking (PCS) at enrollment and magnitude of disability 5-8 months after trauma showed a small correlation (PCS, r=0.26, p=0.034). The Pain Catastrophizing Scale (Beta=0.29; p=0.049), surgery (Beta=0.26; p=0.034), additional surgery (Beta=0.26; p=0.019) and other pain conditions (Beta=0.31; p=0.009) were the significant predictors in the final model (adjusted R-squared=0.35; p<0.001) for greater disability 5-8 months after trauma. DISCUSSION AND CONCLUSIONS In The Netherlands, symptoms of depression measured 1-2 months after musculoskeletal trauma correlate with disability 5-8 months after this trauma. The psychological aspects of recovery from musculoskeletal injury merit greater attention. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- Sjoerd P F T Nota
- Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
| | - Arjan G J Bot
- Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
| | - David Ring
- Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
| | - Peter Kloen
- Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
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Potter MQ, Wylie JD, Greis PE, Burks RT, Tashjian RZ. Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears. Clin Orthop Relat Res 2014; 472:3926-32. [PMID: 25080266 PMCID: PMC4397768 DOI: 10.1007/s11999-014-3833-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. QUESTIONS/PURPOSES This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? METHODS Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. RESULTS Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p = 0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p = 0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p < 0.001). Distress remained associated with higher VAS scores (p = 0.001) and lower Simple Shoulder Test (p < 0.001) and American Shoulder and Elbow Surgeons scores (p < 0.001) when age, sex, BMI, American Society of Anesthesiologists classification, smoking status, tear size, and tear retraction were controlled. CONCLUSIONS Higher levels of psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael Q. Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - James D. Wylie
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Patrick E. Greis
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert T. Burks
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Robert Z. Tashjian
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 USA
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Vranceanu AM, Ring D. Cognitive Coping Predicts Pain Intensity and Disability in Patients with Upper Extremity Musculoskeletal Pain. ACTA ACUST UNITED AC 2014. [DOI: 10.3109/10582452.2014.976326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Briet JP, Bot AG, Hageman MG, Menendez ME, Mudgal CS, Ring DC. The Pain Self-Efficacy Questionnaire: Validation of an Abbreviated Two-Item Questionnaire. PSYCHOSOMATICS 2014; 55:578-85. [DOI: 10.1016/j.psym.2014.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 11/29/2022]
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Bot AG, Bossen JK, Herndon JH, Ruchelsman DE, Ring D, Vranceanu AM. Informed Shared Decision-Making and Patient Satisfaction. PSYCHOSOMATICS 2014; 55:586-94. [DOI: 10.1016/j.psym.2013.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 12/25/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
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Mayland EC, Hay-Smith EJ, Treharne GJ. Recovery-related anxiety and disability following upper limb injury: the importance of context. Disabil Rehabil 2014; 37:1753-9. [DOI: 10.3109/09638288.2014.976719] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Management of intolerance to casting the upper extremities in claustrophobic patients. ScientificWorldJournal 2014; 2014:803047. [PMID: 25379544 PMCID: PMC4213395 DOI: 10.1155/2014/803047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/10/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully.
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