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

The effects of post-traumatic administration of glucose 2.0 g/kg was compared to saline infusion with and without control of brain temperature at 37 degrees C on behavioral and histological measures of brain injury after controlled cortical impact injury complicated by a secondary ischemic insult. The glucose infusion increased blood glucose concentration from 114 +/- 4 to 341 +/- 76 mg/dl prior to the secondary ischemic insult. The resulting outcome measures were significantly worse in the glucose infusion group than in either control group. Mortality rate was significantly increased by the glucose administration, from 0% to 55% (p < 0.001). The median contusion volume was increased from 7.9 to 64.2 by glucose administration (p < 0.001) and the neuronal loss in the CA1 and CA3 areas of the hippocampus were greater in the glucose infusion group. In the animals that survived for the 2 weeks of behavioral studies, the duration of beam balance was shorter; the percent of animals that could balance on the beam for at least 60 s was less, the percent of animals that could perform the beam-walking task was less, and the length of time required to find the platform in the Morris water maze task was longer in the glucose infusion group. These studies demonstrate that the infusion of glucose after the cortical impact injury significantly increases the damage caused by post-traumatic ischemic insults. The adverse effect on neurological outcome could not be explained by the temperature effects of glucose infusion.

Background: Empathy is a key component of a therapeutic relationship. Perceived empathy and compassion are associated with patient satisfaction, reduced symptoms, and adherence to treatment. Objective: To assess the advantages and disadvantages of the validated Jefferson Scale of Patient’s Perception of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy (CARE) tools. Methods: Eighty-four patients completed the JSPPPE and the CARE measure. With Pearson’s correlation and exploratory factor analysis, we measured the underlying construct. Flooring and ceiling effects were measured. Multivariable models were created to assess factors associated with both measures. Results: The high interquestionnaire correlation (rho = 0.70) and factor loading (0.77) confirm that the JSPPPE and CARE measure the same construct. The CARE (55%) had a higher ceiling effect than JSPPPE (18%). Both JSPPPE (partial R 2 = 0.53, 95% confidence interval [CI]: 0.38-0.64) and CARE (partial R 2 = 0.60, 95% CI: 0.46-0.69) accounted for similar amounts of variation in satisfaction with the orthopedic surgeon. Conclusion: Perceived empathy accounts for a substantial amount of the variation in satisfaction. The JSPPPE measures the same construct as CARE with a lower ceiling effect. Because both questionnaires have considerable ceiling effects, a new questionnaire might help to study factors associated with a more empathetic experience.

Background: Perceived physician empathy is a strong driver of patient satisfaction. We assessed the influence of wait time, time spent with the surgeon, and surgeon stress level on the way patients rated surgeon empathy. Methods: One hundred and fourteen patients visiting 1 of 6 participating surgeons were prospectively enrolled in the study. We recorded patient demographics and assessed the patient rating of perceived physician empathy. Time waiting for the surgeon and time spent with the surgeon were measured with use of ambulatory tracking systems and by research assistants with stopwatches outside the patient rooms. Patient ratings of surgeon empathy were assessed with use of the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE), and surgeon stress level was assessed with use of the Perceived Stress Score short form. The mean wait time was 30 ± 18 minutes, and the mean time spent with the surgeon was 8.7 ± 5.3 minutes. Two separate multilevel linear regression models were used to compare factors associated with the JSPPPE and time spent with the surgeon. Results: Neither time spent with the surgeon nor wait time was independently associated with perceived physician empathy; being male, having at least a post-college graduate degree, and higher self-reported surgeon stress levels were independently associated with less perceived empathy. More time spent with the surgeon was independently associated with lower self-reported surgeon stress levels; follow-up visits and visits for a traumatic condition were independently associated with less time spent with the surgeon. Conclusions: The results of the present study show that improved communication strategies, rather than shorter wait time or increased time spent with the patient, may increase patient satisfaction. This should be a focus of future research.

Background Intolerance of uncertainty—the tendency to overestimate the chance of and be unwilling to accept potential, but unlikely, negative outcomes in uncertain situations—is a cognitive construct that has been shown to affect symptoms and limitations for patients with traumatic and nontraumatic upper-extremity conditions. Cognitive flexibility and tolerance of uncertainty can be trained and practiced, with the potential to increase musculoskeletal health. However, to our knowledge, the degree to which intolerance of uncertainty might be associated with symptom intensity and the magnitude of limitations in adults with upper-extremity problems has not been characterized. Questions/purposes After accounting for personal and social factors, is intolerance of uncertainty independently associated with (1) the magnitude of physical limitations and (2) pain intensity? Methods In this cross-sectional, observational study, 139 new and returning patients presenting to one of four orthopaedic offices in a large urban area completed the Intolerance of Uncertainty Scale (a validated measure of the level of comfort with uncertain situations), the Patient-reported Outcomes Measurement Information System—Physical Function Upper Extremity computer adaptive test (to measure the magnitude of limitations), and an 11-point ordinal measure of pain intensity. The mean age of the 139 participants was 51 years ± 16 years and 55% (76 of 139) were men. Participants presented to the clinics with a wide variety of upper-extremity conditions, such as trigger finger, distal radius fractures, lateral epicondylitis, or non-specific shoulder pain. We also assessed sex, race, marital status, education level, income, public versus private insurance, area deprivation index, and the participant’s self-perception of their healthcare experience through a multiple-choice question (answer choices: none, some, a little, and a lot of experience). The following patient characteristics were more common in our study participants: white, employed, part of a married or unmarried couple, and private insurance coverage. We created two multivariable linear regression models to assess factors independently associated with the magnitude of limitations and pain intensity. Results After controlling for potentially confounding variables including sex, insurance, area deprivation index, and type of visit, we found that fewer physical limitations were associated with a greater intolerance of uncertainty (regression coefficient [β] -0.30; 95% confidence interval, -0.50 to -0.10; p = 0.003; semi-partial r2 = 0.07; adjusted r2 for the full model = 0.16), as was being a man (β 3.2; 95% CI, 0.08-6.3; p = 0.045; semi-partial r2 = 0.03) and having private insurance coverage (β 5.2; 95% CI, 2.1-8.2; p = 0.001; semi-partial r2 = 0.08). After controlling for one important potentially confounding variable, the level of education, greater pain intensity was associated with a greater intolerance of uncertainty (β 0.08; 95% CI, 0.02-0.14; p = 0.009; semi-partial r2 = 0.05; adjusted r2 for the full model = 0.08). Conclusions Intolerance of uncertainty—a byproduct of cognitive bias and error, which are elements of the normal functioning of the human mind—increases limitations and pain intensity across diagnoses, independent of demographic and social factors. Future studies can address the effect of strategies that incorporate mindset training (for example, cognitive behavioral therapy and its derivatives) on musculoskeletal symptoms and limitations. Level of Evidence Level II, prognostic study.