Adverse Childhood Experiences Are Not Associated With Patient-reported Outcome Measures in Patients With Musculoskeletal Illness

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 One of the authors certifies that he (DR), or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Skeletal Dynamics (Miami, FL, USA), less than USD 10,000 USD from Wright Medical (Memphis, TN, USA) for royalties for elbow implants, is Deputy Editor for the Journal of Hand Surgery, is Deputy Editor for Clinical Orthopaedics and Related Research®, universities and hospitals, and lawyers outside the submitted work. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review

“…Particularly, accidents such as burns and scalds or high falls have been pointed out to be the most prevalent among social deprived British children (Silversides et al, 2005). Long-term physical consequences might not be expected since adverse childhood experiences have not been associated with musculoskeletal injuries years later (Ottenhoff et al, 2019). Similarly, social deprivation has been also observed to associate with self-harm in both children and adolescents (Ayton et al, 2003).…”

CORR Insights®: Adverse Childhood Experiences Are Not Associated With Patient-reported Outcome Measures in Patients With Musculoskeletal Illness

“…The findings from the current study, however, indicate that "routine" consideration of such issues may not be necessary for the early phase of treatment for patients with musculoskeletal problems [10]. It might be appropriate to limit consideration of ACEs to presentations of chronic pain (and perhaps other presentations for which medical findings are nonexplanatory), and patients for whom potentially harmful elective treatments are being considered.…”

“…Where Are We Now? I n their study, Ottenhoff and colleagues [10] set out to determine whether there is a correlation between adverse childhood experiences (ACEs) and patient-reported outcome measures (PROMs) among patients seeking care in an outpatient upperextremity orthopaedic practice. The authors did not find a reliable association between ACEs and acute pain, or between ACEs and patient-reported physical functioning in a sample of "typical patients seen in outpatient (orthopaedic) offices with common diseases" [10].…”

“…Ottenhoff and colleagues [10] note that their findings may not be generalizable, considering that participants were mostly white and employed with 4 years of college; they correctly pointed out that more research is needed in more-vulnerable populations. A recent study [9] supports that recommendation, in that ACEs were correlated with being black, Hispanic, multiracial, unemployed, homosexual, bisexual, not completing high school, and reporting an annual income of less than USD 15,000.…”

The mind and the hand

“…Asking specifically about their thoughts and feelings regarding symptoms might feel more relevant and could be a better point of discussion (Teunis et al., 2022). Difficult life events (Al Salman et al., 2022) and adverse childhood experiences (Ottenhoff et al., 2019) are also important.…”