Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome

Abstract

Introduction: This study investigates if the psychological subscale from the STarT Back Screening Tool (STarT Psych-sub) identifies patients at high risk of a poor functional outcome after a trapeziectomy based on modifiable psychological factors. Methods: A total of 83 patients completed the STarT Psych-sub, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and a numeric pain rating scale (NPRS) before trapeziectomy. QuickDASH, PEM and NPRS were completed at 6 weeks, 16 weeks and 1 year after the trapeziectomy. Results: The STarT Psych-sub stratified 24 patients (29%) as ‘high-risk’ and 59 (71%) as ‘not high-risk’ of a poor outcome. The ‘high-risk’ group reported worse function and pain (QuickDASH = 72.7, PEM = 81.1, NPRS = 8.3) at baseline than the ‘not high-risk’ group (QuickDASH = 56.1, PEM = 66.4, NPRS = 7.2). This difference remained constant at all time points after the trapeziectomy with 1-year scores on the QuickDASH = 39.6; PEM = 47.1 and NPRS = 3.7 for the ‘high-risk’ group and QuickDASH = 24.3; PEM = 33.3 and NPRS = 1.9 for the ‘not high-risk’ group. Conclusions: Brief psychological screening shows that patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy, however their outcomes are significantly worse than patients who do not have psychological risk factors.

Clinical Evaluation of Post-Surgical Scar Hyperesthesia; an Exploratory Longitudinal Study

“…The STarT Back tool was developed to screen primary care patients with low back pain for prognostic indicators relevant to providing personalized care. However, the measure was recently investigated in patients undergoing trapeziectomy surgery and identified a subgroup of patients at ‘high-risk’ who reported significantly worse outcomes(28). Given the growing evidence that higher levels of anxiety (29, 30) and catastrophic thinking in relation to pain (29, 31) are associated with poorer hand surgery outcome, validation of brief psychological screening tools is an important step in personalized medicine.…”

The mind and the hand

“…A recent study found 29% of patients who accepted an offer of trapeziectomy for trapeziometacarpal arthritis presented with notable opportunities for improving symptoms of anxiety and depression, and unhelpful catastrophic thinking and kinesiophobia (Larson et al., 2022). Although patients experienced a similar magnitude of improvement in comfort and capability 1 year after surgery, the final result was correlated with mindset.…”