Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis

Ottenhoff, Janna S.E.; Teunis, Teun; Janssen, Stein J.; Molen, Aebele B. Mink van der; Ring, David

doi:10.1016/j.jhsa.2019.10.017

Cited by 23 publications

(29 citation statements)

References 46 publications

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“…The finding that plastic surgeons and surgeons from North America are less likely to agree that injection or surgical intervention would address all of the patients' issues is in line with prior studies documenting wide variation in treatment strategy for TMC OA. 28 29 30 It is also in line with a recent study from our research team that found North American surgeons are less likely to recommend surgical treatment than European or surgeons from another region. 29 Birkmeyer et al attributes variation in surgical rates across countries to differences in health care capacity, financial incentives, but also to physicians' beliefs about the indication for surgery.…”

Section: Discussionsupporting

confidence: 86%

“…28 29 30 It is also in line with a recent study from our research team that found North American surgeons are less likely to recommend surgical treatment than European or surgeons from another region. 29 Birkmeyer et al attributes variation in surgical rates across countries to differences in health care capacity, financial incentives, but also to physicians' beliefs about the indication for surgery. 31 Treatment variation might be due to what is perceived as a dearth of high-quality evidence on best treatment for TMC OA or an emphasis on training and personal experience over evidence.…”

Section: Discussionsupporting

confidence: 86%

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Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis

Ottenhoff

Ring

Molen

et al. 2022

Journal of Hand and Microsurgery

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Background There is notable evidence that unhelpful thoughts (symptoms of anxiety and depression) increase symptom intensity among patients with trapeziometacarpal osteoarthritis (TMC OA). Surgeons may or may not be mindful of this line of evidence when interacting with patients. In a survey-based experiment, we randomized surgeons to be prompted about the psychosocial aspects of TMC OA. We aimed to measure the influence of mindfulness of mental health on treatment recommendations and willingness to discuss mental health interventions. Methods We randomized 121 hand surgeons to read one of two paragraphs: (A) about biomedical treatment options for TMC OA, or (B) about the impact of mental and social aspects on TMC OA. Thereafter, surgeons were asked several questions about their opinions and treatment recommendations. Results We found that prompting surgeons with information about the psychosocial aspects of TMC OA did not influence their attitudes or treatment recommendations. Most surgeons were willing to offer patients a workbook (92%) or psychologist referral (84%). Among the few surgeons declining to refer, their reasoning was “it would not be of any help” and “stigmatization.” Conclusion The observation that a paragraph to encourage mindfulness about the psychosocial aspects of TMC OA, which had no influence on surgeon opinions, suggests that awareness may not be a major factor accounting the relatively limited implementation of this evidence in practice to date. Surgeons seem aware of the importance of psychological influence and barriers may include availability, stigma, and a sense of futility. This is a diagnostic study that reflects level of evidence III.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis

Ottenhoff

Ring

Molen

et al. 2022

Journal of Hand and Microsurgery

Self Cite

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“…Ottenhoff et al. demonstrated this in a study of thumb arthritis vignettes where surgeons tended to offer surgery in the setting of increased pain but were less likely to offer surgery when presented with a patient having increasing depressive symptoms [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses

et al. 2022

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“…These observations support literature describing radiographic severity and pain (the primary indication for surgery) as discordant. In fact, the decision to perform surgery for TMOA has been reported as largely subjective (38). Additionally, psychological factors such as illness perception and pain catastrophizing account for 42% of patient pre-treatment pain levels, whereas patient characteristics including radiographic disease severity only accounts for only 6%, leaving more than half of pain levels to unknown contributing factors (39).…”

Section: Discussionmentioning

confidence: 99%

Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression

et al. 2022

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PurposeNon-operative management of trapeziometacarpal osteoarthritis (TMOA) demonstrates only short-term symptomatic alleviation, and no approved disease modifying drugs exist to treat this condition. A key issue in these patients is that radiographic disease severity can be discordant with patient reported pain, illustrating the need to identify molecular mediators of disease. This study characterizes the biochemical profile of TMOA patients to elucidate molecular mechanisms driving TMOA progression.MethodsPlasma from patients with symptomatic TMOA undergoing surgical (n=39) or non-surgical management (n=44) with 1-year post-surgical follow-up were compared using a targeted panel of 27 cytokines. Radiographic (Eaton-Littler), anthropometric, longitudinal pain (VAS, TASD, quick DASH) and functional (key pinch, grip strength) data were used to evaluate relationships between structure, pain, and systemic cytokine expression. Principal Component Analysis was used to identify clusters of patients.ResultsPatients undergoing surgery had greater BMI as well as higher baseline quick DASH, TASD scores. Systemically, these patients could only be distinguished by differing levels of Interleukin-7 (IL-7), with an adjusted odds ratio of 0.22 for surgery for those with increased levels of this cytokine. Interestingly, PCA analysis of all patients (regardless of surgical status) identified a subset of patients with an “inflammatory” phenotype, as defined by a unique molecular signature consisting of thirteen cytokines.ConclusionOverall, this study demonstrated that circulating cytokines are capable of distinguishing TMOA disease severity, and identified IL-7 as a target capable of differentiating disease severity with higher levels associated with a decreased likelihood of TMOA needing surgical intervention. It also identified a cluster of patients who segregate based on a molecular signature of select cytokines.

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Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis

Cited by 23 publications

References 46 publications

Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis

Surgeons Attitude toward Psychosocial Aspects of Trapeziometacarpal Osteoarthritis

Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses

Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression

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