The Association of Education Level on Outcome after Distal Radius Fracture

Abstract

Background Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture. Methods A series of patients with distal radius fractures (n = 335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12 months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured. Results Complete demographic and 12-month follow-up data were available on 227 patients (75 %). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score. Conclusions Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patientrelated factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.

Epidemiology of distal radius fractures and factors predicting risk and prognosis

“…A prospective case series of 227 adults with DRF treated operatively or nonoperatively and followed over 12 months after injury found that each increase in the level of education (eg, from high school to some college) doubled the rate of improvement over time in pain, wrist range of motion, grip strength, and disability. 116 This was because education is known to be a robust determinant of socioeconomic status, which in turn is highly associated with the outcomes among patients with DRF. 116 Moreover, highly educated people with DRF tend to change their jobs more easily to move to a work environment, which is less physically stressing in comparison to less educated patients who are often employed in low-income jobs requiring manual labor.…”

“…116 This was because education is known to be a robust determinant of socioeconomic status, which in turn is highly associated with the outcomes among patients with DRF. 116 Moreover, highly educated people with DRF tend to change their jobs more easily to move to a work environment, which is less physically stressing in comparison to less educated patients who are often employed in low-income jobs requiring manual labor. 17 Also, it is possible that those with high levels of education (whether retired or employed) might be more financially stable and better able to access and adhere to rehabilitation therapy programs.…”

The Effect of Socioeconomic Status on the Choice of Treatment for Patients With Cruciate Ligament Injuries in the Knee: A Population-Based Cohort Study

“…The influence that SES has on healthcare has been widely recognized (75). Higher SES has been associated with a higher access to and utilization of surgical and pharmacological treatments as well as better outcomes after treatment (76)(77)(78)(79)(80). Education is probably the best single indicator representing SES (81,82).…”

The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review

“…All but 1 study was of moderate quality (SEQES score, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Lower levels of education were found to be associated with decreased range of motion 6 weeks after DRF in a prospective cohort study aimed to identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after DRF surgery.…”