Department of Orthopaedic Surgery, MGH Orthopaedic Hand & Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2013 Jan 2;95(1):76-81. doi: 10.2106/JBJS.L.00064.
Upper-extremity-specific disability correlates with mood and coping strategies. The aim of this study was to determine if two psychological factors, kinesiophobia (fear of movement) and perceived partner support, contribute significantly to variation in upper-extremity-specific disability in a model that included factors known to contribute to variation such as depression, pain anxiety, and catastrophic thinking.
We performed an observational cross-sectional study of 319 patients who each had one of the following conditions: trigger finger (n = 94), carpal tunnel syndrome (n = 29), trapeziometacarpal arthrosis (n = 33), Dupuytren contracture (n = 31), de Quervain syndrome (n = 28), wrist ganglion cyst (n = 32), lateral epicondylosis (n = 41), and a fracture of the distal part of the radius treated nonoperatively six weeks previously (n = 31). Each patient completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and questionnaires measuring symptoms of depression, pain anxiety, catastrophic thinking, kinesiophobia, and perceived level of support from a partner or significant other. Stepwise multiple linear regression was used to determine significant independent predictors of the DASH score.
Men had significantly lower (better) DASH scores than women (21 versus 31; p < 0.01). DASH scores also differed significantly by diagnosis (p < 0.01), marital status (p = 0.047), and employment status (p < 0.01). The DASH score correlated significantly with depressive symptoms (p < 0.01), catastrophic thinking (p < 0.01), kinesiophobia (p < 0.01), and pain anxiety (p < 0.01) but not with perceived partner support. The best multivariable model of factors associated with greater arm-specific disability (according to the DASH score) included sex, diagnosis, employment status, catastrophic thinking, and kinesiophobia and accounted for 55% of the variation.
In this sample, kinesiophobia and catastrophic thinking were the most important predictors of upper-extremity-specific disability in a model that accounted for symptoms of depression, anxiety, and pathophysiology (diagnosis) and explained more than half of the variation in disability. Perceived partner support was not a significant factor. The consistent and predominant role of several modifiable psychological factors in disability suggests that patients may benefit from a multidisciplinary approach that optimizes mindset and coping strategies.
上肢特定残疾与情绪和应对策略相关。本研究的目的是确定两个心理因素，运动恐惧（害怕运动）和感知到的伴侣支持，是否在一个包含已知导致残疾变化的因素的模型中，对上肢特定残疾的变化有显著贡献，如抑郁、疼痛焦虑和灾难性思维。
我们对 319 名患者进行了一项观察性横断面研究，每位患者都有以下一种情况：扳机指（n=94）、腕管综合征（n=29）、腕掌关节炎（n=33）、掌腱膜挛缩症（n=31）、De Quervain 综合征（n=28）、腕关节腱鞘囊肿（n=32）、肱骨外上髁炎（n=41）和六周前非手术治疗的桡骨远端骨折（n=31）。每位患者完成了上肢残疾问卷（DASH）和问卷，测量抑郁症状、疼痛焦虑、灾难性思维、运动恐惧和感知到的伴侣或重要他人的支持程度。逐步多元线性回归用于确定 DASH 评分的显著独立预测因子。
男性的 DASH 评分明显低于女性（21 分比 31 分；p<0.01）。DASH 评分也因诊断（p<0.01）、婚姻状况（p=0.047）和就业状况（p<0.01）而显著不同。DASH 评分与抑郁症状（p<0.01）、灾难性思维（p<0.01）、运动恐惧（p<0.01）和疼痛焦虑（p<0.01）显著相关，但与感知到的伴侣支持无关。与上肢特定残疾（根据 DASH 评分）相关的最佳多变量模型包括性别、诊断、就业状况、灾难性思维和运动恐惧，占残疾变化的 55%。
在本样本中，运动恐惧和灾难性思维是解释抑郁、焦虑和病理生理学（诊断）症状的模型中上肢特定残疾的最重要预测因子，解释了残疾变化的一半以上。感知到的伴侣支持不是一个重要因素。几个可改变的心理因素在残疾中持续且占主导地位，这表明患者可能受益于多学科方法，优化思维和应对策略。
