The effectiveness of cognitive behavioural therapy for patients with concurrent hand and psychological disorders

Abstract

We investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with psychological disorders thought to be influencing recovery from elective and traumatic hand conditions. Demographic data and psychological assessment scores (Primary Health Questionnaire 9 (PHQ9), General Anxiety Disorder Assessment (GAD7), Impact of Event Scale (IES)) were prospectively collected before and after CBT treatment. One hundred and fourteen patients underwent CBT with 81 completing treatment. Full data was available for 78 (68%) patients. Mean age was 43 (range 13–84) and 63% were women. Sixty-one per cent had sustained a traumatic hand injury. PHQ9, GAD7 and IES scores decreased significantly following treatment. Many patients with hand conditions have associated psychological problems that may influence outcome. CBT in a hand unit setting appears to be an effective treatment. Further research with a control group should investigate whether CBT improves psychological health or if this may occur as patients recover from their physical hand disorder regardless of CBT. Level of evidence: IV

CORR Insights®: When Musculoskeletal Clinicians Respond to Empathetic Opportunities, do Patients Perceive Greater Empathy?

“…I rarely saw the patients whom I referred for CBT, and I’d hear from the therapy team that they were feeling better. A retrospective review of the CBT intervention found that measures of psychologic distress improved after CBT [1]. This was definitely my experience with the service during my fellowship.…”

“…Any member of the multidisciplinary team of hand therapists, surgeons, and nurses could refer a patient for CBT. A review of the service found that although most clinicians did not have formal training in psychology, they could identify patients with psychologic problems [1]. Referrals for treatment required patients’ consent, of course, and this necessitated a sensitive discussion that some clinicians may have been concerned about having.…”

“…Julia Blackburn MD 1 Where Are We Now? I n this month's Clinical Orthopaedics and Related Research ® , Pierson et al [2] reviewed transcripts of musculoskeletal consultations and found that when physicians responded to opportunities to show empathy during office visits-supporting patients who shared concerns about their conditions or described how their lives were affected by those conditions-those office visits were not substantially longer.…”

The mind and the hand

“…Greater symptoms of PTSD are associated with assault and workplace injuries, road traffic accidents, age under 55 years, female gender and upper compared with lower limb injuries (Alarcon et al., 2012). There is evidence that cognitive behavioural therapy can help to reduce the psychological disturbance and improve comfort and capability (Grunert et al., 1990; Lucas et al., 2022). Psychological assessment and support is an integral part of the current management of injured military personnel in the UK (Roberts et al., 2022).…”

Wrist & Hand

“…Authors from Derby (UK) investigated the effectiveness of cognitive behavioural therapy (CBT) for patients with concurrent hand and psychological disorders. 2 CBT is a type of psychotherapy that helps people change the way they think and behave, and can be used to treat a variety of mental health conditions, including depression, anxiety, and stress. CBT works by helping to identify and change negative thought patterns and behaviours.…”