Bot Arjan G J, Souer J Sebastiaan, van Dijk C Niek, Ring David
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, USA.
Hand (N Y). 2012 Dec;7(4):407-12. doi: 10.1007/s11552-012-9447-8.
Symptoms and psychosocial factors are suggested to account for more of the variation in disability than physical impairment, but perhaps less so at the level of specific tasks. This study assessed the influence of impaired wrist motion on specific tasks on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.
Sixty-three patients with an operatively treated fracture of the distal radius completed the Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale, and Center for Epidemiologic Studies Depression Scale (CES-D) just before surgery and the DASH questionnaire 3 months after surgery. Nine questions on the DASH were selected as potentially sensitive to changes in wrist motion and evaluated in bivariate and multivariable analyses.
In multivariable models of factors associated with specific tasks, only "Open a tight or new jar" was affected by wrist flexion and PCS accounting for 33 % of the variation. Motion, pain, and PCS were significant predictors of the DASH score. Among the eight tasks not related to wrist motion, 33 % of the variation in disability with writing was accounted for by PCS and limb dominance; 20 % of disability preparing a meal by pain, CES-D, and PCS; 14 % of disability with making a bed by pain and CES-D; and 23 % of changing a light bulb overhead by age, pain, and fracture type.
After volar plate fixation of a fracture of the distal radius, upper extremity disability based on select items from the DASH questionnaire correlated minimally with impairment of wrist motion, even at the level of specific tasks.
Prognostic Level II.
症状和社会心理因素被认为比身体损伤能解释更多残疾方面的差异，但在特定任务层面可能解释得较少。本研究评估了腕关节活动受限对《上肢、肩部和手部功能障碍量表》（DASH）问卷中特定任务的影响。
63例接受手术治疗的桡骨远端骨折患者在手术前完成了疼痛灾难化量表（PCS）、疼痛焦虑症状量表和流行病学研究中心抑郁量表（CES-D），并在术后3个月完成了DASH问卷。从DASH问卷中选取9个对腕关节活动变化可能敏感的问题，并进行双变量和多变量分析。
在与特定任务相关因素的多变量模型中，只有“打开一个紧的或新的罐子”受腕关节屈曲和PCS影响，占变异的33%。活动、疼痛和PCS是DASH评分的显著预测因素。在与腕关节活动无关的八项任务中，PCS和肢体优势占书写残疾变异的33%；疼痛、CES-D和PCS占准备膳食残疾的20%；疼痛和CES-D占整理床铺残疾的14%；年龄、疼痛和骨折类型占更换头顶灯泡残疾的23%。
桡骨远端骨折掌侧钢板固定术后，基于DASH问卷所选项目的上肢残疾与腕关节活动受限的相关性最小，即使在特定任务层面也是如此。
预后II级。
