Factors Associated with Outcome in Extremity Surgery

Abstract

Introduction: Understanding musculoskeletal disability is essential for the treatment protocols of surgeons. Associations between mental health measures and disability have been studied extensively in Upper-extremity injuries but less so in lower extremity trauma patients.It is less clear which factors are most consistently associated with disability in the orthopaedic lower-extremity trauma population and which outcome measurements are used to represent disability. Questions:(1) What factors are most consistently associated with disability after lowerextremity injuries in adults? (2) What are the trends in types of outcome measures used to represent disability and conceptualization of disability in patients with lower-extremity injuries. Methods:We conducted searches in PubMed (NLM), Web of Science (Clarivate) and CINAHL (EBSCO). No limits were imposed for publication type except for publication dates (2000 through current), language (English), and age (adult only). Our search provided 6298 unique entries. Of these studies, 8 involved traumatic conditions in which disability was measured and psychological variables were tested.Results: Greater magnitude of disability after lower extremity injury was most consistently associated with symptoms of depression (6 cohorts) and symptoms of anxiety (2 cohorts).Other psychological factors associated with disability included pain interference (1 cohort), pain catastrophizing (1 cohort), kinesiophobia (1 cohort) and pain self-efficacy (1 cohort).Satisfaction of social life and the level of activity were also correlated with disability. The Patient Reported Outcome Measure Information System Computer Adaptive Test (PROMIS CAT) 1) Physical Function, 2) Depression and 3) Anxiety were most frequently used to measure disability, depression and anxiety, respectively. Of the 8 included studies, 3 were of moderate quality and 5 were of high quality. Conclusion:Symptoms of depression are most commonly associated with disability after a lower extremity trauma. Future longitudinal studies may focus on factors associated with 13 specific lower extremity trauma on both short and long term to better understand disability in this population and study the effects of several factors on recovery.