Correspondence of patient word choice with psychologic factors in patients with upper extremity illness.

BACKGROUND

Studies of patients with back pain, cancer, and in a general medical practice note that the use of certain phrases by a patient when communicating with their health provider can indicate greater disability and distress than expected for patients with a given disorder. However, it is unclear whether such phrases apply to patients with hand and arm disorders.

QUESTIONS/PURPOSES: We assessed whether specific patient phrases are associated with symptoms, disability, and psychologic factors in patients with hand and arm disorders.

METHODS

We recorded and coded 61 interviews of new patients. Specific expressions of patients were listed and categorized into six phrase categories: "I can't", "Find it and fix it", "Something is wrong", "It's serious", "Deemphasis (hoping)", and "Protective mindset". Patients completed questionnaires for arm-specific disability (DASH), depression (Patient Health Questionnaire [PHQ-9]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), and heightened illness concern (Whiteley Index).

RESULTS

Patients who endorsed phrases in the category "I can't" had higher scores on the PCS, Whiteley, DASH, and pain; they also had longer visits. Patients expressing "Something is wrong" had higher scores for the PCS, pain, and duration of visit. Patients using "It's serious" had a higher score for pain. Finally, patients using "Protective mindset" had lower PHQ-9 scores and younger age.

CONCLUSIONS

Patient word choice may indicate underlying distress or ineffective coping strategies that represent important opportunities for empathy and support, including evidence-based cognitive and behavioral interventions.

LEVEL OF EVIDENCE

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.