Early Psychological and Social Factors Explain the Recovery Trajectory After Distal Radial Fracture

Jayakumar, Prakash; Teunis, Teun; Vranceanu, Ana‐Maria; Lamb, Sarah E; Ring, David; Gwilym, Stephen

doi:10.2106/jbjs.19.00100

Cited by 62 publications

(67 citation statements)

References 41 publications

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“… 11 , 12 After injury and fracture, continued use of opioids is associated along with psychological factors such as greater pain catastrophization, fear of movement, lower self-efficacy, and long-term disability. 12 , 13 For those undergoing surgery, preoperative opioid dependence and fracture complexity are important risk factors for postoperative opioid dependence after fracture fixation, however these are not easily modifiable by treating surgeons. 12 , 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

Factors associated with persistent opioid use after an upper extremity fracture

et al. 2021

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Aims The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. Cite this article: Bone Jt Open 2021;2(2):119–124.

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Section: Introductionmentioning

confidence: 99%

Factors associated with persistent opioid use after an upper extremity fracture

et al. 2021

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“…37 This suggests that provided a long enough follow-up period, patients undergoing ORIF for a distal radius fracture function similar to the general population, regardless of social deprivation and other biopsychosocial factors that may be impactful in the early recovery phase. 7 We also found that regardless of whether the patients' final radiographic parameters were within the AAOS criteria or not, there was no clinically relevant or statistically significant difference between each group's QuickDASH score. 38 There has been a large amount of research on the radiographic parameters that are the most important to restore after a distal radius fracture.…”

Section: Discussionmentioning

confidence: 55%

Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation

Zeidan

Stephens

Zhang

et al. 2021

Journal of Hand Surgery Global Online

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Although baseline biopsychosocial factors are associated with short-term patient-reported outcomes following distal radius fracture open reduction internal fixation (ORIF), their effect on midterm outcomes is unclear. We aimed to evaluate the effect of social deprivation, previously established as a surrogate for depression, pain interference, and anxiety, on quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores >1 year following distal radius ORIF. Methods: Adult patients (!18 years) with an isolated distal radius fracture treated with ORIF by orthopedic trauma and hand surgeons at a single tertiary academic center over a 3-year period were included. Outcomes at !1 year postoperatively were evaluated using QuickDASH. Age, follow-up duration, area deprivation index (ADI; a measure of social deprivation), subspecialty (hand vs trauma), and postoperative alignment were assessed using linear regression with 95% confidence intervals after bootstrapping and a permutation test for P values to test for their association with the final QuickDASH score. Results: Follow-up data were obtained for 98 of 220 (44.5%) patients at a mean of 3.1 ± 1.0 years after surgery. Mean age and ADI were 53.2 ± 15.4 years and 26.8 ± 18.7, respectively. Most fractures were intra-articular (67.3%), and 72.4% had acceptable postoperative alignment parameters, as defined by the American Academy of Orthopaedic Surgeons clinical practice guidelines. The mean QuickDASH score was 13.0 ± 16.5. There were no significant associations between the final QuickDASH score and any studied factor, including ADI, as determined using univariable analysis. Multivariable analysis showed no association between ADI and the final QuickDASH score, independent of age, sex, treating service, follow-up duration, and fracture alignment or pattern. Conclusions: At mid-term follow up after distal radius ORIF, ADI did not correlate with QuickDASH scores, and the QuickDASH scores of the patients did not differ from those of the general population. However, our cohort mostly comprised patients with levels of deprivation below the national median. Although studies have shown that the short-term outcomes of distal radius ORIF are influenced by biopsychosocial factors, outcomes at the time of final recovery may not be associated with social deprivation. Type of study/level of evidence: Prognostic IV.

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“…PROMIS can reliably identify clinical, social, and psychological risk factors for poor outcomes. [25][26][27][28][29][32][33][34][35]. Its weaknesses are lack of specificity for certain body parts, its lack of validation for mental health outcomes, and its ceiling effect in certain active patient populations [23,32,35].…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27][28][29][32][33][34][35]. Its weaknesses are lack of specificity for certain body parts, its lack of validation for mental health outcomes, and its ceiling effect in certain active patient populations [23,32,35]. Future research will be directed toward further validation of PROMIS for specific injuries and body regions as well as the incorporation of the mental health profile.…”

Section: Discussionmentioning

confidence: 99%

“…Outcome assessment using PROMIS has revealed the importance of social and psychological factors in the lives of patients [32][33][34][35]. Jayakumar et al found that social and psychological factors such as being retired, using antidepressants, having greater pain interference, and greater pain catastrophizing explained the majority of physical limitation as measured by PROMIS Upper Extremity at 6-9 months following treatment of distal radius fractures [32]. As mentioned previously, pain interference is the perceived consequence of pain on one's life [1].…”

Section: Capturing Social and Psychological Influence On Outcomes With Promismentioning

confidence: 99%

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Patient-Reported Outcome Measurement Information System (PROMIS) in Orthopaedic Trauma Research

Sperring

Danford

Saltzman

et al. 2021

SICOT-J

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This review describes the development, advantages and disadvantages, and applications of the Patient-Reported Outcome Measurement Information System (PROMIS) in orthopaedic trauma. PROMIS is a useful tool for quantifying outcomes in orthopedic trauma. It allows measurement of outcomes across multiple domains while minimizing administration time. PROMIS also reliably identifies clinical, social, and psychological risk factors for poor outcomes across a variety of orthopaedic injuries and disease states. However, PROMIS lacks specificity for certain anatomic regions and validation for mental health outcomes. It also is limited by ceiling effects in certain active patient populations. Orthopaedic traumatologists should be familiar with PROMIS, as its use is increasing and it is a valuable tool that can aid in clinical decision making.

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Early Psychological and Social Factors Explain the Recovery Trajectory After Distal Radial Fracture

Cited by 62 publications

References 41 publications

Factors associated with persistent opioid use after an upper extremity fracture

Factors associated with persistent opioid use after an upper extremity fracture

Evaluating the Impact of Social Deprivation on Mid-Term Outcomes Following Distal Radius Open Reduction Internal Fixation

Patient-Reported Outcome Measurement Information System (PROMIS) in Orthopaedic Trauma Research

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