Psychosocial factors affecting variation in patient-reported outcomes after elbow fractures

Abstract

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

“…Our work supports a growing body of evidence that objective markers of illness such as clinical or radiographic injury severity, and type of treatment (operative or not) account for a limited amount of variation in the magnitude of limitations measured by PROMs (32)(32)(33)(34) (35). In our model, injury severity (represented by fracture classification, energy level, neurovascular compromise and open or closed injury) and whether or not surgery was performed, did not account for any of the variability in limitations.…”

Symptoms of depression and catastrophic thinking attenuate the relationship of pain intensity and magnitude of incapability with fracture severity

“…A systematic review of population studies which combined diagnosis, clinical signs and symptoms of knee osteoarthritis (OA), confirms the discordance between radiographic severity of knee OA and associated magnitude of incapability [4]. Psychological factors may explain this discordance with growing evidence for the dominant association between mental health with pain intensity and incapability across a range of musculoskeletal conditions [5,17,18,20,21,31,38,40].…”

“…This study involves secondary use of data from a published longitudinal cohort study of 731 adult patients recovering from proximal humerus, elbow, and distal radius fractures [17][18][19] (Table 1). The original research and ethics committee approved study (IRAS No.16/ YH/0017) addressed factors at baseline associated with longer-term activity tolerance [17][18][19]. Enrollment occurred between January 1, 2016 and August 31, 2016.…”

“…We sought to better understand the relationship between variations in PROMs, objective pathophysiology, and both the symptoms of distress (depression) and unhelpful thinking (pain catastrophization) following arm fractures using moderation analysisa method which determines the extent to which the magnitude of the relationship between independent variables (i.e., level of fracture severity) and dependent variables (i.e., pain intensity or magnitude of incapability) are associated with a third variable, the moderator (i.e., depression or catastrophic thinking). While the negative association between psychological factors and recovery are well-recognized, going one step further to better understand the interplay between unhelpful thoughts and distress, PROMs, and fracture severity at different stages of the recovery trajectory may help develop more comprehensive patient-centered care plans [17][18][19].…”

Impact of Social Determinants of Health in Spine Surgery

“…These pillars of SDH have been documented in various medical specialties ranging from pediatrics to neurosurgery. [6][7][8][9][10][11][12][13][14][15][16][17][18]. Even in the present day of the SARS-CoV-2 pandemic, COVID-19 mortality has been associated with SDH [12,18].…”