Opsteegh Lonneke, Reinders-Messelink Heleen A, Groothoff Johan W, Postema Klass, Dijkstra Pieter U, van der Sluis Corry K
Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, Groningen, The Netherlands.
J Hand Surg Am. 2010 Jun;35(6):961-7. doi: 10.1016/j.jhsa.2010.03.024.
Symptoms of posttraumatic stress disorder (PTSD) in patients with hand injuries may delay return to work, even when criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV are not met. This study investigated which biomedical and psychosocial factors relate to symptoms of acute PTSD in hand-injured patients.
Sixty-seven employed patients with hand injuries completed a number of questionnaires. The following factors were investigated: sociodemographic characteristics, injury severity, accident location, pain, satisfaction with hand functioning, aesthetics of the hand, social support, and coping styles. The primary outcome measure was the number of symptoms of PTSD. We analyzed factors that were univariately significantly associated with symptoms of PTSD using linear regression analysis, and explored interaction effects.
One patient met the criteria for PTSD; 44 patients experienced symptoms but did not meet the criteria (median, 1; interquartile range (IQR), 0-2); 22 patients experienced no symptoms of PTSD. Patients had a median pain score of 30 (IQR, 10-45), median satisfaction score of 60 (IQR, 45-70), median aesthetics score of 66.7 (IQR, 45.8-79.2), median palliative coping style score of 16 (IQR, 14.8-17.3), and median avoidance coping style of 15 (IQR, 13-16). Symptoms of PTSD were associated with pain (r, .530; p < .001), satisfaction with hand function (r, -.451; p < .001), aesthetics (r, -.320; p = .009), palliative coping style (r, .281; p = .022) and avoidance coping style (r, .283; p = .022). Pain and aesthetics remained significant after regression analysis. No interaction effects were significant.
Pain and aesthetics statistically predict symptoms of acute PTSD in patients with acute hand injuries. Patients with disproportionate pain or dissatisfaction with aesthetics should be evaluated for PTSD.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
手部受伤患者的创伤后应激障碍（PTSD）症状可能会延迟其重返工作岗位，即便不符合《精神疾病诊断与统计手册》第四版的标准。本研究调查了哪些生物医学和社会心理因素与手部受伤患者的急性PTSD症状相关。
67名手部受伤的在职患者完成了多项问卷调查。调查了以下因素：社会人口统计学特征、损伤严重程度、事故发生地点、疼痛程度、对手部功能的满意度、手部美观度、社会支持和应对方式。主要结局指标是PTSD症状的数量。我们使用线性回归分析单因素分析中与PTSD症状显著相关的因素，并探讨交互作用。
1名患者符合PTSD标准；44名患者有症状但不符合标准（中位数为1；四分位间距（IQR）为0 - 2）；22名患者没有PTSD症状。患者的疼痛评分中位数为30（IQR为10 - 45），满意度评分中位数为60（IQR为45 - 70），美观度评分中位数为66.7（IQR为45.8 - 79.2），姑息性应对方式评分中位数为16（IQR为14.8 - 17.3），回避性应对方式评分中位数为15（IQR为13 - 16）。PTSD症状与疼痛（r = 0.530；p < 0.001）、对手部功能的满意度（r = -0.451；p < 0.001）、美观度（r = -0.320；p = 0.009）、姑息性应对方式（r = 0.281；p = 0.022）和回避性应对方式（r = 0.283；p = 0.022）相关。回归分析后，疼痛和美观度仍具有显著性。无显著的交互作用。
疼痛和美观度在统计学上可预测急性手部受伤患者的急性PTSD症状。对于疼痛程度不成比例或对美观度不满意的患者，应评估其是否患有PTSD。
研究类型/证据水平：预后性研究IV级
