The assessment of psychological factors on upper extremity disability: A scoping review

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.

Adjustment to hand injury: Cross-sectional survey exploring adjustment in relation to illness perceptions and coping strategies

STUDY DESIGN

Cross-sectional descriptive.

INTRODUCTION

Hand injuries are highly prevalent, and the impact they have on physical, emotional, and functional adjustment is well recognized. Increasingly, adjustment to health conditions including hand injuries is being understood in terms of psychological variables.

PURPOSE OF THE STUDY

To examine the role of illness beliefs and coping strategies in adjustment to hand injury. Adjustment was considered from a complete perspective including quality of life (QOL) and functional ability as well as mood and trauma symptoms.

METHODS

Cross-sectional survey whereby consecutive patients (n = 65) attending the regional plastic surgery service with hand injuries were invited to complete a questionnaire assessing illness perceptions, coping strategies, QOL, hand functioning, depression, and trauma symptoms. Data were analyzed in SPSS (IBM Corporation, Armonk, NY) by correlation and then hierarchical regression analysis.

RESULTS

Illness perceptions and coping strategies were significantly related to the adjustment outcomes (hand functioning, QOL, depression, and trauma symptoms). Specifically, poorer adjustment was associated with more negative illness beliefs (r = 0.31-0.47), greater use of denial (r = 0.24-0.53), and avoidance-based (r = 0.41-0.64) coping strategies.

DISCUSSION

Illness beliefs and coping play an important role in adjustment after hand injury. Adjustment is multifaceted with a need to consider physical and emotional functioning. More optimistic beliefs and adaptive coping styles are associated with improved adjustment.

CONCLUSION

The role of psychological variables in optimizing adjustment is an important consideration for the design of psychological interventions, but because this study was cross sectional and cannot assume directional effects, future longitudinal studies are needed.

LEVEL OF EVIDENCE

N/A.

Upper Extremity Care for Children: Unique Medical and Psychosocial Aspects

Hand surgeons encountering pediatric patients should be attuned to both technical and practical facets of caring for congenital and traumatic pathologies. Psychosocial aspects include engaging children in conversation and factoring in both self and external perception of deformity. Medical considerations are also unique, from including child abuse in the differential to having techniques to assess active motion and sensation in the nonverbal child. Certain universal principles, such as minimizing radiation exposure and limiting needle sticks, have higher emphasis in pediatric patients than in adults. With these aspects in mind, treating children and their families can be a mutually rewarding experience.

The influence of age on quality of life after upper body burn

BACKGROUND

In Spain, the number of aged persons is increasing. By the year 2066, it is expected that 34.6% of the Spanish population will be over 65 years of age. Elderly people present a higher burning risk owing in part to impaired balance and decreased physical strength, lower cognitive abilities, or socioeconomic context.

OBJECTIVE

Burns to the upper body body are common and affect both emotional state and physical function, thus leading to reduced quality of life (QoL). Our objective was to determine the influence of age on the QoL of patients who experienced burns to the upper body, with burns with 2 years.

METHODS

This is an observational study with a sample of 58 patients with burns only on the upper body. Patients were divided into two groups: 29 patients of age over 65 years and 29 patients under 65 years; all of them attended the Vall d'Hebron Burn Center, Barcelona, between 2011 and 2014. From the original sample, 45 patients had survived by the time the information was gathered. The QoL of these individuals was evaluated with the Spanish version of the Burn Specific Health Scale. Demographic data (sex, age, total burn surface area [TBSA], burn mechanism, pathological history, length of hospital stay, and rehabilitation duration) were collected. Statistical analysis included parametric and nonparametric tests as appropriate with R3.3.3.

RESULTS

There were no differences between groups regarding the mechanism of burn, TBSA, length of hospital stay, and the domains of QoL test. High blood pressure, diabetes, and other comorbidities were significantly more common in the elderly group than in the younger group. Eleven patients died in the elderly group and two in the younger group (p=0.012).

CONCLUSION

As opposed to what could be expected, in this study, there were no significant differences between surviving patients in both age groups in terms of perceived QoL. Nevertheless, mortality after a burn in the upper side of the body was significantly higher in elderly people than in younger people. The present study results do not support the use of different rehabilitation approaches in elderly patients.

Factors affecting time off work in patients with traumatic hand injuries-A bio-psycho-social perspective

Hand injuries are common and can result in a long time off work. To analyse and identify factors affecting time of work, a holistic view on patients is needed. World Health Organization's International Classification of Functioning, Disability and Health (ICF) with its bio-psycho-social perspective provides such a holistic view. The purpose of this study is to analyse time off work in patients with traumatic hand injuries and to identify factors affecting time off work from a bio-psycho-social perspective. We used factors derived from the ICF Core Set for Hand Conditions to predict time off work by applying Cox regression analyses and Kaplan-Meier method using data of a multicentre prospective study in nine German Level 1 hand trauma centres. In total, 231 study participants with a broad range of hand injuries were included. From these, 178 patients (77%) returned to work within 200 days. Impairments in mobility of joint functions and sensory functions related to temperature and other stimuli as well as higher hand strain at work led to extended time off work. Gender, fine hand use and employment status additionally influenced time off work in sub-models. Our results demonstrate that a bio-psycho-social perspective is recommended when investigating time off work.

The Use of Psychosocial Services Post Hand and Upper Limb Injury and Trauma: A Pilot Study

BACKGROUND

Research demonstrates that hand injuries may cause psychological difficulties. To enhance recovery, therapists must provide appropriate referrals. The purpose of this study was to explore the use of psychosocial services by occupational therapists (OTs) and certified hand therapists (CHTs) post hand and upper limb injury or trauma.

METHODS

A quantitative survey design was implemented using a self-made questionnaire, which consisted of questions regarding demographic information, types and frequency of hand and upper limb injuries, psychiatric diagnoses, frequency of psychosocial service referrals, frames of references used, types of psychosocial assessments and interventions employed, and barriers to psychosocial services. The questionnaire was randomly distributed to 29 therapists.

RESULTS

The most frequently recorded frame of reference was the Biomechanical. Only 17.2% participants implemented psychosocial assessments. Sixteen of the 29 participants referred to 9 possible psychosocial services; however, majority of referrals were "occasionally." OTs specialized in mental health, behavioral specialists, and social workers were recorded with the least amount of referrals. A Spearman rank correlation found a weak, but significant inverse relationship between referrals by therapists and years of experience as an OT or CHT (-0.322 and -0.351, P < .05, respectively).

CONCLUSIONS

Therapists appear to be biomechanically oriented which may impact outcomes. An inverse correlation was found where the less experience participants had, the more likely they were to refer to psychosocial services. The results emphasized the lack of psychosocial assessments, interventions, and referral services being used by therapists. Further education to therapists, third parties, and other health professionals is warranted.

Hand Posturing Is a Nonverbal Indicator of Catastrophic Thinking for Finger, Hand, or Wrist Injury

BACKGROUND

Prior research documents that greater psychologic distress (anxiety/depression) and less effective coping strategies (catastrophic thinking, kinesophobia) are associated with greater pain intensity and greater limitations. Recognition and acknowledgment of verbal and nonverbal indicators of psychologic factors might raise opportunities for improved psychologic health. There is evidence that specific patient words and phrases indicate greater catastrophic thinking. This study tested proposed nonverbal indicators (such as flexion of the wrist during attempted finger flexion or extension of uninjured fingers as the stiff and painful finger is flexed) for their association with catastrophic thinking.

QUESTIONS/PURPOSES

(1) Do patients with specific protective hand postures during physical examination have greater pain interference (limitation of activity in response to nociception), limitations, symptoms of depression, catastrophic thinking (protectiveness, preparation for the worst), and kinesophobia (fear of movement)? (2) Do greater numbers of protective hand postures correlate with worse scores on these measures?

METHODS

Between October 2014 and September 2016, 156 adult patients with stiff or painful fingers within 2 months after sustaining a finger, hand, or wrist injury were invited to participate in this study. Six patients chose not to participate as a result of time constraints and one patient was excluded as a result of inconsistent scoring of a possible hand posture, leaving 149 patients for analysis. We asked all patients to complete a set of questionnaires and a sociodemographic survey. We used Patient Reported Outcomes Measurement Information System (PROMIS) Depression, Upper Extremity Physical Function, and Pain Interference computer adaptive test (CAT) questionnaires. We used the Abbreviated Pain Catastrophizing Scale (PCS-4) to measure catastrophic thinking in response to nociception. Finally, we used the Tampa Scale of Kinesophobia (TSK) to assess fear of movement. The occurrence of protective hand postures during the physical examination was noted by both the physician and researcher. For uncertainty or disagreement, a video of the physical examination was recorded and a group decision was made.

RESULTS

Patients with one or more protective hand postures did not score higher on the PROMIS Pain Interference CAT (hand posture: 59 [56-64]; no posture: 59 [54-63]; difference of medians: 0; p = 0.273), Physical Function CAT (32 ± 8 versus 34 ± 8; mean difference: 2 [confidence interval {CI}, -0.5 to 5]; p = 0.107), nor the Depression CAT (48 [41-55] versus 48 [42-53]; difference of medians: 0; p = 0.662). However, having at least one hand posture was associated with a higher degree of catastrophic thinking (PCS scores: 13 [6-26] versus 10 [3-16]; difference of medians: 3; p = 0.0104) and a higher level of kinesophobia (TSK: 40 ± 6 versus 38 ± 6; mean difference: -2 [CI, -4 to -1]; p = 0.0420). Greater catastrophic thinking was associated with a greater number of protective hand postures on average (rho: 0.20, p = 0.0138).

CONCLUSIONS

Protective hand postures and (based on prior research) specific words and phrases are associated with catastrophic thinking and kinesophobia, less effective coping strategies that hinder recovery. Surgeons can learn to recognize these signs and begin to treat catastrophic thinking and kinesophobia starting with compassion, empathy, and patience and be prepared to add formal support (such as cognitive-behavioral therapy) to help facilitate recovery.

LEVEL OF EVIDENCE

Level III, diagnostic study.

Do hand outcome measures reflect cultural influences?

OBJECTIVE

The aim of this study was to compare the activities listed in DASH, MHQ, QuickDASH with the activities listed in Canadian Occupational Performance Measure (COPM) in a Turkish patient population with hand injury.

METHODS

COPM questionnaire was administered to 163 participants (61 male and 102 female; mean age 40.72 ± 13.70 years). The activities that were stated in COPM were categorized and checked whether they were present in DASH-T, MHQ, QuickDASH.

RESULTS

The highest rated stated activities were "carrying a heavy object" (39.2%), "cleaning the house" (25.7%) and "writing" (15.9%). DASH reflects 30% whereas MHQ and QuickDASH reflect 16.32% and 10.2% of the problematic activities, respectively.

CONCLUSION

None of three questionnaires have satisfactory results for reflecting the problematic activities among hand injured Turkish people. Open ended interviews should be irrevocable part of assessment process in order to describe a person-center treatment program.

Assessment of quality of life (QoL) of burn patients in India using BSHS-RBA scale

INTRODUCTION

The Burn Specific Health Scale-Brief (BSHS-B) is a popular instrument to measure quality of life (QoL) in burn patients. The current study aims at identifying the prognostic variables for our burn population using the BSHS-RBA (revised, brief and adapted) scale.

MATERIALS AND METHODS

The study was conducted on 60 post-burn patients using the BSHS-RBA scale. The questionnaire was administered by an interview as majority of patients were illiterate. The socio-demographic and clinical variables were analyzed against domain scores and total scores of the scale, using Mann-Whitney test and Kruskal Wallis test.

RESULTS

The median age of the sample was 28 years, of which 60% were females. Their median TBSA burn was 30%. The median time since burn at the time of interview was 10 months. Higher scores were noted in the domains of simple abilities and mobility, hand function and interpersonal relationship, while poorer scores were recorded in domains of skin sensitivity and body image.

DISCUSSION

The mean score in our study was 2.36, which is quite less as compared to reports from high income countries (range: 2.58-3.36). This study provides an insight on an aspect of burn care outcome, which can be reasonably expected in low income countries with the available standard of care. Being a female, presence of hand and face burn, requirement of corrective surgeries and inability to resume work were factors associated with poor QoL.

CONCLUSION

Strategies to improve QoL of burn patients should target psychological aspects, work rehabilitation (early release of contractures) and skin hypersensitivity (including itching) to derive maximum benefit.

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

BACKGROUND

Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions.

QUESTIONS/PURPOSES

(1) Do patients with nontraumatic conditions have different preferences for shared decision-making when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decision-making?

METHODS

In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity.

RESULTS

There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, -0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decision-making. More educated patients preferred a more active role in decision-making (beta = -0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making.

CONCLUSIONS

Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.

[Study on sociopsychological factors in patients with occupational hand injury]

OBJECTIVE

To investigate the role of sociopsychological factors in occupational hand injury and to provide a reference for intervention measures.

METHODS

The sociopsychological factors in 150 patients with occupational hand injury who were admitted to the Department of Hand Surgery from January to June in 2014 and 150 pair-matched normal controls were surveyed using self-made questionnaire and Life Event Scale (LES). A comparative study was carried out using t test, χ² test, and conditional logistic regression analysis.

RESULTS

The demographic characteristics, such as length of service, education level, and marital status, showed significant differences between the two groups (P<0.05) ; the LES total score and values of positive life events and negative life events also showed significant differences between the study group and control group (P<0.01) ; single-factor and multi-factor conditional logistic regression analyses showed that length of service, marital status, and negative events score were statistically significant variables (P<0.01).

CONCLUSION

Sociopsychological factors play an important role in the occurrence of occupational hand injury.

The experience of living with a traumatic hand injury in a rural and remote location: an interpretive phenomenological study

INTRODUCTION

The aim of this research study was to gain an understanding of how rural and remote residents in North Queensland, Australia, engaged in work, activities of daily living tasks and social activities following a traumatic hand injury. Findings from a previous retrospective survey with these participants revealed that patients experienced difficulties such as pain for many years after their injury; however, because of the survey methodology, the voices of participants were not heard. This study contributes to a larger project that seeks to propose a model of service delivery to rural and remote residents who have sustained a traumatic injury.

METHODS

Utilising an interpretive phenomenological research design, data were gathered through in-depth, semistructured interviews. Fifteen participants were recruited into this study and questions were designed to explore the experience of having a traumatic hand injury in rural and remote areas of North Queensland.

RESULTS

The thematic analysis indicated five major themes: injury and impairment, pain, occupation and activity, and resilience. Participants reported that having a hand injury often caused further injury due to the impairment. The pain experienced could be 'all consuming' yet participants reported 'pushing through' this pain to complete daily tasks. Participants reported that they would 'go mad' if they did not work and highlighted the importance of activity in their recovery. Participants felt grateful at having their hand and thought towards the future. Being self-reliant was important but they were willing to accept support from others when needed.

CONCLUSIONS

Incorporating activity and occupation in rehabilitation programs as opposed to focusing on strict protocols is an important consideration in the recovery process of rural and remote residents. In particular, engaging in activity and occupation was an important part of managing the pain associated with the hand trauma. This research also found that participants demonstrated resilient qualities while recovering from a traumatic hand injury. Health professionals who work with people from a rural and remote location with a traumatic hand injury should consider a treatment model that encourages active patient participation, identifying collaborative treatment goals that align with the values of people living in rural and remote locations. Education regarding the high risk of further injury due to the nature of, and exposure to, the type of work and activity in rural and remote locations is also recommended.

Recovering from traumatic occupational hand injury following surgery: a biopsychosocial perspective

PURPOSE

Significant differences occur in the return-to-work (RTW) period amongst workers with an acute traumatic occupational hand injury. This study aimed to develop and test a comprehensive multivariate conceptual biopsychosocial model to predict RTW outcome.

METHOD

Patients presenting with an occupational hand injury were interviewed 7-10 days after their injury (N = 192) and again at 4 weeks after their injury (n = 150). Potential determinants from biomedical, work-related, demographic and psychosocial categories were studied simultaneously.

RESULTS

A small sub-set of workers with an acute traumatic hand injury experienced chronic disability beyond 12 weeks. Analyzing the relationship between predictor variables and work absence resulted in the identification of the most important determinants of recovery. During the acute stages of recovery, injury severity, pain, self-efficacy, and living alone were the most important determinants of delayed RTW outcome. At 4 weeks post-injury, locus of control, injury severity, negative affect and living alone were the most important predictors of delayed RTW.

CONCLUSION

A number of prognostic variables were identified that influenced RTW outcome, which offer new and unique contributions to the field. Injury severity was not the most important determinant of RTW outcome; neither were factors identified in previous hand injury research, such as attribution of blame, significant predictors. Factors not examined in previous research, such as negative affect, were more important determinants of delayed RTW.

[Cartoons, local anesthesia and nitrous oxide: a solution for the treatment of child's hands wounds]

Wounds and injuries of child's hands are common and create anxiety. The context of stress makes difficult therapeutic cares, anesthesia and surgery, and prevents child's cooperation. We propose a technique combining a local anesthesia performed during inhalation of oxygen and nitrous oxide, and child distraction by watching a cartoon. In a prospective series of 39 children, we evaluated the feasibility of such care and its impact on the child's anxiety by a visual analog scale (VAS) at three moments of care sequence: arrival of the child (EVA1), at the end of the cartoon (EVA2), and at the postoperative visit (EVA3). Thirty-seven children were included (94.9%). Mean anxiety decreased throughout the therapeutic course: EVA1 (5.6), EVA2 (2.97), EVA3 (1.4). Children were less and less anxious along the procedure (100%, 46%, 10.8%, respectively). All children could be treated as outpatients. This procedure allows a rapid and adapted treatment for children's hand injuries. It reduces impact of children's anxiety.

The use of motivational interviewing to manage behavioral changes in hand injured clients

Individuals vary in the degree in which they are willing to make significant changes in areas of their daily life, especially after an illness or injury. Motivational interviewing (MI) has been used to predict a persons' readiness to change and to build the necessary intrinsic motivation that is needed to make difficult changes. The article describes the stages of change model and strategies that can be applied to patients in different stages of change. Vignettes are provided to apply the various principles of MI and to assist hand therapists with an approach that supports the recovery efforts of their patients.

Behavioural treatment of post‐traumatic and vibration‐induced digital cold sensitivity

Cold sensitivity is a common problem after all types of hand injuries. The aim of the present study was to assess possible effects of treatment by Pavlovian conditioning, a behavioural treatment method for digital cold sensitivity where whole body cold exposure becomes associated with warm hands. Eighteen hand-injured patients and nine patients with vibration-induced problems in their hands completed the treatment. Questionnaires and questions, assessment of perception of touch/pressure and skin temperatures after cold provocation, was made before and after the completed period of treatment and after 6 and 12 months. The results indicated subjective improvement in the hand-injured group in contrast to a lack of response in the vibration group. An increased digital skin temperature after treatment was noted for the vibration-exposed group only, which however did not persist at 6 and 12 months' follow-up.

Against the odds or odds-on chance: pathways of coming back among hand-injured workers in the Chinese context

In this study, I used a hermeneutic phenomenological approach by means of thematic analysis to examine the lived experiences of hand-injured workers in Hong Kong. Twenty-seven informants with moderate to severe disabilities were interviewed over ten years about how they lived through their disability and their discourses were examined in the cultural context. Three categories (survivors, achievers, strugglers) were synthesized from the informants' life courses. Each category was analyzed under three themes: biographical disruption, working with a disability, and linking family and significant others, but these three categories proved fluid and subject to individual life course and contextual factors. All informants had to work "against the odds." Most returned to work after recovery but some tended to drift within the labor market. Human agency and situated context facilitated achievers to progress through "odds-on chance." Outcome measures of rehabilitative interventions that focus on returning to employment might underestimate the sequelae of being disabled in society.

Severe mutilating injuries to the hand: guidelines for organizing the chaos

Major hand injuries have become a rarity in Western countries. The fact that there are well trained teams devoted to their management, should not obscure the fact that the first emergency surgeon has the major role of setting the foundations for a reconstruction. Understanding the goal to be sought: the 'acceptable hand' (one with three fingers, with near normal length, near normal sensation and a functioning thumb), is hoped to be of great help in primary care. Preservation of vital structures such as joints, flexor tendons, and vessels, in the initial debridement, which will help to build this 'acceptable hand' are discussed. The general guidelines for management of finger amputation and soft tissue problems are also given.

Changes in life roles after hand injury

This study examines how acute hand injuries affect patients in their roles as spouse, caregiver, and/or worker. Qualitative data from patient interviews were used to analyze how these life roles were affected by the individuals' hand injuries. Data were extracted from interviews of three hand patients who had one or more roles of spouse, caregiver, and/or worker affected by their injury. Data were then examined and categorized for each life role by participant. Participants' views of how hand therapy affected their recovery and resumption of occupational role performance were also examined. Results showed that the participants expressed profound degrees of change in their ability to perform satisfactorily in their various life roles.

Emotional Distress and Psychosocial Resources in Patients Recovering From Severe Burn Injury

Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. However, patients also reported high levels of resources such as general optimism, self-efficacy, and perceived social support. Within the sample, no significant correlation between severity of emotional distress and severity of burn injury was found. By psychological assessments a subgroup of highly distressed patients was identified. These patients were highly emotionally distressed while having objective injury severity comparable with the other patients in the sample. Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.

Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: A questionnaire survey

BACKGROUND

Emotional distress is frequent in patients with acute traumatic hand injury during the first weeks after the accident. Knowledge of coping in relation to emotional distress could help to identify those who need support.

OBJECTIVES

To describe the different kinds of coping used by patients in the early stage of recovery following an acute traumatic hand injury and to investigate differences in coping patterns in patients with and without symptoms of emotional distress.

DESIGN

Questionnaire survey with a descriptive and comparative design.

SETTING/PARTICIPANTS

A total of 112 patients with acute traumatic hand injury requiring inpatient treatment at the hand surgical clinic. Those with injuries caused by a suicide attempt or with known drug abuse were excluded. Method/main outcome measures: The patients answered a postal questionnaire at home 1-2 weeks after the accident. Emotional distress was assessed with the Hospital Anxiety and Depression scale. Coping was measured with the Jalowiec Coping Scale-40.

RESULTS

Coping by "trying to keep the situation under control" and "trying to look at the problems objectively and see all sides" were most frequent. These strategies are typical for the confrontive coping style, which dominated in the actual illness-situation. Symptoms of emotional distress occurred in 32% of the patients. These patients used significantly more kinds of coping strategies and used confrontive and emotive coping strategies more often than the others. Coping by "hoping for improvement", "working tension off with physical activity", "trying to put the problem out of one's mind", "worrying", "getting nervous or angry" and "taking off by one self" were associated with emotional distress. Coping by "accepting the situation as it is" and "thinking that it is nothing to worry about" were more frequent in patients without emotional distress.

CONCLUSIONS

Observations of the coping strategies associated with emotional distress in this study could help to identify patients in clinical practice that need nursing support. Coping associated with less emotional distress should be encouraged.

The clinical and psychosocial challenges associated with bilateral hand traumas

This case study highlights the importance of providing holistic and multidisciplinary care when managing patients with complex bilateral traumatic hand wounds. Such collaboration can achieve optimum results.

Teachers' perceptions of and responses to adolescents with chronic pain syndromes

OBJECTIVE

To examine factors that influence teachers' perceptions of and responses to chronic pain in students.

METHODS

Two-hundred and sixty classroom teachers responded to a vignette describing a student with limb pain. The 2 x 2 x 2 factorial design included conditions that varied by (a) the presence or absence of documented organic evidence for the pain, (b) cooperative vs. confrontational parent-teacher interactions, and (c) the presence or absence of communication from the medical team. Teachers rated pain severity and impairment, relief from classroom responsibilities, extent of accommodations the student would require in school, and sympathy for the student and family.

RESULTS

Documented medical evidence supporting the pain was the most influential factor affecting teachers' responses to pain. Parental attitude also influenced responses. Communication from the medical team influenced teachers' decisions about relief from responsibilities but did not affect other reactions.

CONCLUSIONS

Teachers' responses to students with pain are influenced by situational factors. Efforts to increase school functioning in youth with chronic pain should incorporate attempts to help teachers respond to pain adaptively.

Contrasting perspectives on pain following hand injury

The purposes of this article are 1) to compare contrasting ways of documenting pain, 2) to identify the usefulness of information each method provides, and 3) to examine implications for hand therapy. Participants are tracked for 12 months in an ongoing study of Adaptation to Hand Injury that incorporates quantitative measures of both intensity and functional impact of pain, as well as semistructured qualitative Adaptation Interviews that elicit and document patients' responses to pain and injury experience. Each method of documenting pain tells us something important. Numeric measures of pain intensity (Visual Analog Scale) allow us to document change over time and identify relationships between intensity and self-reported changes in daily life as documented in a structured questionnaire (Disabilities of Arm, Shoulder, and Hand). Qualitative interviews provide an individual perspective on responses to pain and disability and the personal beliefs and experiences that influenced the responses of each unique individual. Findings support the importance of studying more about the clinical behaviors of our patients for better treatment outcomes and recommend the use of qualitative research in helping us to uncover this knowledge.

Problems experienced during the first year of an acute traumatic hand injury - a prospective study

BACKGROUND

Evidence-based nursing of patients with acute traumatic hand injuries treated at the hand-surgical clinic calls for knowledge about long-term implications.

AIMS AND OBJECTIVES

The aim of the study was to investigate consequences of an acute traumatic hand injury during the first year after the accident. Specifically, the objectives were to investigate changes in the experience of physical and psychological problems over time, frequencies of remaining problems and the impact of the injury on work situation and life situation 1 year after the accident.

DESIGN

The study was prospective and followed the patients from the first weeks to 1 year after the accident.

METHOD

Ninety-one patients were assessed three times during the year. Each time the patients answered study-specific questions, the Impact of Event Scale and the Hospital Anxiety and Depression Scale.

RESULTS

Problems experienced decreased during the first 3 months but tended to remain unchanged during the rest of the year. In the 1-year follow-up, the majority of the patients experienced slight or moderate functional limitations in the hand, one-third had symptoms of trauma-related distress and one out of seven had troublesome pain. Half of the patients who had returned to work reported a worse work situation and 16% were still on the sick list. One-third of all patients considered their whole life situation to be worse as a result of the injury. Patients with amputations more often experienced a worse life situation. Blue-collar workers reported functional limitations and a worse life situation more often than white-collar workers.

CONCLUSIONS

Patients with acute traumatic hand injuries requiring surgical treatment may experience problems, such as functional limitations, trauma-related distress and troublesome pain, with long-term implications for their work situation and life situation.

RELEVANCE TO CLINICAL PRACTICE

Caring for hand-injured patients should include, not only surgical treatment and other actions for restoring the function of the hand, but also preventive action and follow-up of trauma-related distress and pain.

Motivation in hand-injured patients with and without work-related injury

The purpose of this study was to examine similarities and/or differences in the motivational constructs of hope and optimism for the future, attitude toward disability, goal setting, and perceived social support at work between hand-injured participants with and without work-related injury. A purposive sample of eight participants was interviewed to gather a qualitative "insider's perspective." Interviews were conducted at three time points to identify any evolution of participants' motivational constructs over time. Motivational constructs between the two groups were found to be similar. Being optimistic, having a positive attitude toward the disability, setting goals in therapy, having supportive employers and colleagues at work, and having the desire to overcome dependency on others were found to promote participants' motivation for recovery. Findings contributed to the existing knowledge of patients' motivation in rehabilitation. Therapists could use these findings as facilitation strategies to promote patients' motivation for recovery in hand rehabilitation.

A multiple-schedule evaluation of immediate and subsequent effects of fixed-time food presentation on automatically maintained mouthing

The purpose of this study was to evaluate the immediate and subsequent effects of fixed-time (FT) food presentations on mouthing. The effects of FT food presentations were analyzed within a three-component multiple schedule in which baseline conditions were implemented during the first and third components and treatment conditions were implemented during the second component. Results indicated that FT food reduced mouthing and that levels of mouthing during post-FT components were reliably lower than pre-FT components. Behavioral mechanisms responsible for treatment effects are discussed.

Adaptation to Hand Injury: An Evolving Experience

OBJECTIVES. Objectives of this study were to examine similarities and differences in physical recovery and psychosocial adaptation, engagement in occupations and relationships, perceived outcomes and expectations, and adaptive issues and strategies of 5 participants from an ongoing longitudinal study of adaptation to hand injury.

METHODS. Participants were tracked for 12 months using quantitative measures of physical recovery and psychosocial adaptation, and qualitative adaptation interviews focused on the impact of an injury experience in clients’ daily lives. A computerized graphic format documented changes over time in key quantitative and qualitative indicators in individual Adaptation Trajectories.

RESULTS. Findings included the importance of motivating occupations and relationships, changes over time in expectations for the future, and differences between independent and interdependent adaptive strategies following hand injury.

DISCUSSION. Connections between the International Classification of Functioning and Disability domains of body systems, activity capabilities, and social participation were examined. Findings support the value of individualized, occupation-based therapy that addresses the mind and spirit as well as physical recovery in occupational therapy practice with hand injury clients.

Use of a Symptom Validity Test in the forensic assessment of Posttraumatic Stress Disorder

Symptom Validity Tests (SVTs) employ a two-alternative, forced-choice method to assess an individual's motivation to perform. The strategy is routinely used by neuropsychologist with plaintiffs who allege brain injury, but heretofore has not been applied to the forensic assessment of posttrauma claims. The present case report applied an accepted SVT, the Portland Digit Recognition Test, to the forensic assessment of Posttraumatic Stress Disorder. Findings illustrate how SVTs can be useful in any forensic or disability case that presents with memory complaints.

The science and medicine of cricket: an overview and update

Research into the science and medicine underlying cricket performance and injury has progressed since the First World Congress of Science and Medicine in Cricket in 1999. This review covers material on the physiological and psychological demands of the game and preparation for it, the biomechanics and motor control of cricket skills, the psychology of team dynamics, performance analysis and cricket injuries. Technological aspects of cricket equipment are also covered, where such research could influence injury risk or player performance. Fielding remains the least studied of the skills. Much more research needs to be done before we can gain a full understanding of the scientific aspects of the game. There is a need to address common definitions of injury, along with more research into injury mechanisms. Research on batting needs to bring together motor control and biomechanics more fully. The fitness demands of the game are still poorly understood, along with the mechanisms causing fatigue. Evaluation of the efficacy of intervention strategies needs to continue and to develop. The applications of research need to be communicated more to coaches and players--for example, in team dynamics--so that they can be applied, and tested further, in international matches.

Trauma-related distress and mood disorders in the early stage of an acute traumatic hand injury

The aim of the study was to estimate the incidence of trauma-related distress and mood disorders in the early stages after acute traumatic hand injuries and identify characteristics associated with these reactions. Data were obtained from 112 patients by means of mailed questionnaires and medical records. Nearly half of the patients had increased levels of intrusive and avoidance symptoms, indicating trauma-related distress. One-third showed signs of a mood disorder. Mood disorders were associated with the need for help with activities of daily living, pain and avoidance symptoms. The study showed that emotional problems in the early stages after injury are related to the consequences of both the injury and the traumatic experience. Negative reactions to the sight of the hand were associated with both trauma-related distress and mood disorders, suggesting that observation of the reactions to the sight of the hand could help to identify patients in need of psychological support.

Return to work outcomes after work-related hand trauma: the role of causal attributions

PURPOSE

This study examined the relationship between workers' judgments of responsibility for their accidents (causal attributions) and work-site avoidance after work-related injuries.

METHODS

Ninety-two hand-injured workers referred for psychologic treatment of posttraumatic stress and depressive symptoms were assessed for their beliefs about the cause(s) of their accidents. Causal attributions were obtained before and after psychologic intervention.

RESULTS

Workers who blamed coworkers or equipment for their injuries were more likely to resist returning to former work activities than workers who judged themselves responsible for their accidents. In addition those with relatively minor injuries were as much at risk for work-site avoidance as those with more severe injuries. Age, gender, and length of employment with current employer were unrelated to avoidance.

CONCLUSIONS

These results suggest the importance of causal attributions as potential predictors of work-site avoidance after traumatic work-related hand injuries, and support the risk for psychologic symptom development after less-severe injuries.

Examination and interface with the musician

Musicians are special patients and this fact has to find expression in the history taking and examination of musicians. The consulting hand surgeon has to develop a consistent concept of history taking and examination that respects all the specific facets of the musician's environment and techniques, besides and beyond the usual hand surgical standards. There has to be an emphasis on exhaustive examination of subtle technical and ergonomic details, which in many cases reveals the pathogenic origin or source of the musician's complaint. From this can be delivered the clues for establishing the specific solutions and therapy concepts, whereas the standard hand surgical concepts might be misleading.

Hand and wrist fractures

The upper extremities provide support, protection, and pleasure in the everyday activities of work, fun, sports, driving, and writing. When an upper extremity sustains an injury, it has a dramatic effect on quality-of-life issues. As professional caregivers, it is important to have a comprehensive understanding of the the effects of upper extremity fractures. The assessment of the patient with an upper extremity should consist of the general health of the patient after a traumatic event, determination of the mechanism of injury, assessment of the fracture site, confirmation of the exact injury, identification of potential complications, and assessment of the patient's social and professional statuses to identify potential problems that might affect treatment and rehabilitation

Hand and wrist fractures

The upper extremities provide support, protection, and pleasure in the everyday activities of work, fun, sports, driving, and writing. When an upper extremity sustains an injury, it has a dramatic effect on quality-of-life issues. As professional caregivers, it is important to have a comprehensive understanding of the effects of upper extremity fractures. The assessment of the patient with an upper extremity should consist of the general health of the patient after a traumatic event, determination of the mechanism of injury, assessment of the fracture site, confirmation of the exact injury, identification of potential complications, and assessment of the patient's social and professional statuses to identify potential problems that might affect treatment and rehabilitation.

Psychological aspects of mutilating hand injuries

The immediate and long-term outcome of a mutilating hand injury can be positively influenced by health care professionals adopting a biopsychosocial perspective toward treatment and management. Such an injury produces a psychological and social impact that should be openly and candidly addressed with the injured individual and with the family. The earlier and the more skillfully these issues are addressed, the more likely it is that psychological factors will not impede functional outcome.

[Industrial hand injuries by punch machines: a case-control study]

OBJECTIVE

To identify factors associated with industrial hand injuries by punch machines.

METHODS

From September, 1999 to June, 2000, 108 patients of industrial hand injuries by punch machines were collected. For each patient, 2 controls were randomly selected. One was from the same industry; the other was from a big industry with thousands of punch machines. They matched on gender, job and age. In-person interviews were conducted to collect data on demographics, work history, work characteristics, work injuries, work organization, health behaviors, anthropometric and psychological factors. The Eysenck Personality Questionnaire (EPQ) was selected to evaluate the psychological performance. Risk factors were examined via multivariate logistic regression techniques.

RESULTS

There were four important factors affecting hand injuries by punch machines: The first was the length of service index (odds ratio [OR] = 0.972, 95% confidence interval [CI] = 0.957, 0.988). The second index was neuroticism (OR = 1.649, 95% CI = 1.264, 2.151). A safety equipment index (OR = 0.260, 95% CI = 0.123, 0.547) and a safety operation criterion index (OR = 0.136, 95% CI = 0.064, 0.286) were also significant factors.

CONCLUSIONS

Results suggest that the accident-prone population are those who have shorter service length and neurotic psychological performance. It may reduce the incidence of industrial hand injuries by punch machine to strengthen the appliance of safety equipment and enforcement of safety operation criterion, especially to the accident-prone population.

A qualitative study of coping in the early stage of acute traumatic hand injury

Twenty patients with acute traumatic hand injury were interviewed 8-20 days after the day of the accident. The aim of the study was to identify coping strategies, defined as thoughts or actions used by the hand-injured patients to manage stress factors and resulting emotions in the early stage. Stress factors were reported in an earlier study. The analyses of the interviews followed the first steps in the analytical process described in a modified model of grounded theory. Eleven different coping strategies were identified in the interviews. By "comparing with something worse", "positive thinking", "relying on personal capacity", "distancing" and "distracting attention" the patients tried to play down the seriousness of the problem or situation. Other coping strategies used by the hand-injured were "accepting the situation", "seeking social support", "maintaining control", "solving practical problems by oneself", "pain-relieving actions" and "active processing of the trauma experience." The findings of the study show how important it is to identify the patient's own way of coping with a stressful illness situation in order to give adequate psychosocial support.

Hand infection associated with clenched fist syndrome in residents of long-term care facilities

1. Clenched fist syndrome is a clinical entity in which no organic disease can be found. 2. The syndrome usually follows a minor inciting incident and is associated with swelling, pain, and paradoxical stiffness. 3. Patients with severe forms of clenched fist syndrome may experience infections of the palm or joints.

[Psychology during the process of human hand allograft]

OBJECTIVE

To study the psychology and its management during the process of hand allograft.

METHODS

One psychologist participated through the whole process of the present hand allograft. 12 potential candidates of hand transplant were interviewed during the selection of patients to evaluate the state of psychiatry and their abilities to manage stressors like cooperation with medical workers and medical interventions, waiting for donors, adaptation to a new hand and post operation depression. The psychological state of 11 patients were believed to be able to receive hand transplant, and they are further prepared psychologically by the psychologist while waiting for a donor. Two lucky candidates were decided by tissue typing and received hand allograft simultaneously. After the operation, the two patients psychotherapy assisted with effective analgesia, supporting from family and environmental improvement.

RESULTS

One out of 12 patients was found not suitable for the transplantation because of psychiatric problem. One week postoperation, the 2 patients were anxious, lack of patience, and horrified at seeing the long-expected grafted hand. After 1 week of treatments and adapation the patients managed to settle with the new hand, and accepted the hand as a whole 1 month postoperation. With the recovery of the hand sensation and motion 4 to 5 months postoperation, the patients held the hand as his own.

CONCLUSION

Psychologists are required in the hand transplantation team during the pre-transplant selection of patients and post-transplant rehabilitation.

Functional outcome of high-pressure injection injuries of the hand

BACKGROUND

High-pressure injection (HPI) injury of the hand is a serious injury that can be potentially devastating. There have been a number of publications on the results of its treatment, but we are not aware of a report on the functional outcome of these hands.

METHODS

We assessed the functional outcome of 15 patients with HPI injuries. All patients were treated operatively, with a mean delay of 11.7 hours. The patients were examined by a doctor and an occupational therapist using a work simulator.

RESULTS

Our study revealed a significant reduction of static and dynamic muscle testing parameters compared with the uninjured hand. Six patients lost a digit and four patients had to change their occupation after the injury.

CONCLUSION

Deterioration of hand function is a predictable outcome of HPI injury. This information should be shared with the patient at the outset so as to avoid subsequent disappointment.

[New approach to hand dressings in young children: the puppet dressing]

Applying a postoperative dressing on a child's hand is a very important matter, for it must be done rigorously and according to well established principles in order to be effective and inoffensive. The strictness of execution, that holds the surgeon's attention, makes us sometimes forget that the dressing is for a child who is usually anxious. First, we recall the general principles of a postoperative dressing adapted to young children. Then, we explain a method of applying a dressing in the shape of a puppet, which at first can appear to be funny, but seriously which is completely adapted to a young child. This pediatrician adaptation, that parents appreciate very much, makes the situation less stressful because the child finds himself in a game situation. The puppet dressing seems to be an advantageous modification of the traditional dressing of a child's hand.

The Injured Workers Survey: development and clinical use of a psychosocial screening tool for patients with hand injuries

Hand therapists often recognize that their patients are experiencing psychosocial distress following traumatic hand injury but may lack the time and training to determine whether referral for psychological assessment and treatment is warranted. The Injured Workers Survey (IWS) is a brief, effective self-report tool that screens for psychosocial distress, in particular for characteristic symptoms of post-traumatic stress disorder (PTSD). It also collects clinically relevant information about other psychosocial issues that have a major effect on treatment outcomes. A recent research study has validated the IWS as a screen for PTSD and supports its routine use in the initial assessment of all patients with traumatic hand injuries. To the extent that psychosocial distress interferes with recovery, its early identification and treatment can optimize overall treatment outcomes and facilitate successful in return to work.