Farzad Maryam, Asgari Ali, Dashab Fatemeh, Layeghi Fereydoun, Karimlou Masoud, Hosseini Seyed Ali, Rassafiani Mehdi
Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Educational Psychology, The University of Kharazmi, Tehran, Iran.
Clin Orthop Relat Res. 2015 Nov;473(11):3470-6. doi: 10.1007/s11999-015-4228-7.
Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored.
QUESTIONS/PURPOSES: The purpose of this study was to determine if disability (as measured by the Disabilities of the Arm, Shoulder and Hand [DASH] and the Michigan Hand Questionnaire [MHQ]) and pain intensity correlate with impairment (as measured by the American Medical Association [AMA] impairment guide). Secondary study questions addressed the effect of pain intensity and symptom of depression on predicting disability.
Impairment and disability were evaluated in a sample of 107 hand-injured patients a mean of 11 months after injury. Impairment rating was performed prospectively. From the patients who came for therapy, they were invited to fill out the questionnaire and evaluated for impairment rating. Response variables of DASH, MHQ, and visual analog scale pain intensity values were collected at the same setting. Other explanatory variables included demographic, injury-related, and psychological factors (symptoms of depression measured with the Beck Depression Inventory). Initial bivariate and multivariate analyses were performed to determine correlations of disability and pain to impairment rating and other exploratory variables.
Disability as measured by the DASH showed intermediate correlation with AMA impairment (r = 0 .38, beta = 0.36, p = 0.000). Together with gender, it accounted for only 22% of the variability in DASH scores. Similarly, MHQ score correlated with impairment rating (r = -0.24, beta = -0.23, p < 0.05). However, together with age, injured hand accounted for only 19% of the variability in MHQ scores. However, pain intensity did not correlate with impairment (r = -0.46, p > 0.05). Interestingly, pain intensity did correlate with the time passed from surgery but it was correlated with symptom of depression (r(2) = 0.10, beta = 0.33, p = 0.001).
The limited correlation between impairment and disability emphasizes the importance of factors other than pathophysiology in human illness behavior. These may include physical (pain, dominant injured hand) and conditional factors (time since surgery) or psychological factors such as depression and adapting; all mentioned can be considered as personal factors that may be different in each patient. So considering personal difference and any other condition except the impairment alone can help to better plan interventions and also diminish disability level.
Level III, therapeutic study.
身体功能和结构的任何丧失或偏差都被视为损伤，而活动受限是残疾定义的基本要素。虽然两者似乎直观上应密切相关，但情况可能并非如此；有证据表明，心理社会因素比客观损伤更能决定残疾。然而，这种情况的程度尚未得到充分探讨。
问题/目的：本研究的目的是确定残疾（通过手臂、肩部和手部功能障碍[DASH]和密歇根手部问卷[MHQ]测量）和疼痛强度是否与损伤（通过美国医学协会[AMA]损伤指南测量）相关。次要研究问题涉及疼痛强度和抑郁症状对预测残疾的影响。
在107例手部受伤患者受伤平均11个月后的样本中评估损伤和残疾情况。前瞻性地进行损伤评级。从前来接受治疗的患者中，邀请他们填写问卷并进行损伤评级评估。在同一环境下收集DASH、MHQ的反应变量以及视觉模拟量表疼痛强度值。其他解释变量包括人口统计学、损伤相关和心理因素（用贝克抑郁量表测量的抑郁症状）。进行初始双变量和多变量分析，以确定残疾和疼痛与损伤评级及其他探索性变量之间的相关性。
用DASH测量的残疾与AMA损伤呈中度相关（r = 0.38，β = 0.36，p = 0.000）。与性别一起，它仅占DASH评分变异性的22%。同样，MHQ评分与损伤评级相关（r = -0.24，β = -0.23，p < 0.05）。然而，与年龄一起，受伤手仅占MHQ评分变异性的19%。然而，疼痛强度与损伤不相关（r = -0.46，p > 0.05）。有趣的是，疼痛强度与手术时间相关，但与抑郁症状相关（r² = 0.10，β = 0.33，p = 0.001）。
损伤与残疾之间的有限相关性强调了除病理生理学之外的因素在人类疾病行为中的重要性。这些因素可能包括身体因素（疼痛、优势受伤手）和条件因素（手术时间）或心理因素，如抑郁和适应；所有这些都可被视为可能因患者而异的个人因素。因此，考虑个人差异以及除损伤之外的任何其他情况有助于更好地规划干预措施并降低残疾水平。
III级，治疗性研究。
