Yeoh Jane C, Pike Jeffrey M, Slobogean Gerard P, OʼBrien Peter J, Broekhuyse Henry M, Lefaivre Kelly A
The Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
J Orthop Trauma. 2016 May;30(5):228-33. doi: 10.1097/BOT.0000000000000514.
This study examines depression and outcomes in patients older than 55 years with distal radius fracture.
Prospective data collection included patient characteristics, treatment, general and limb symptoms and disability, and complications at baseline, 3 months, and 1 year. Bivariate analysis and multivariable linear regression were used to assess relationships between depression and outcome measures, specifically the Short Form-36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH) scores, and the Centre of Epidemiologic Studies Depression (CES-D) scale.
The study was conducted in a level-1 trauma center.
All patients older than 55 years with isolated distal radius fracture were recruited (2007-2011).
Patients were treated operatively or nonoperatively.
The SF-36 and DASH scores measured general and upper extremity status. Depression was measured using CES-D scale. All complications were recorded.
Of 228 patients, 25% were depressed at baseline, 32% at 3 months, and 26% after 1 year. Thirty-two patients (14%) had complications. There was no relationship between depression at baseline and complications; however, there was a statistically significant relationship at 3 months (P = 0.021). There was a statistically significant association between baseline depression and the worse 1-year SF-36. Patients with baseline depression had poorer 1-year DASH scores (20 ± 2.3) than nondepressed patients (11 ± 1.3) (P = 0.0031), and less improvement in DASH scores over the first year (P = 0.023). Multivariable linear regression demonstrated that baseline depression is the strongest predictor of poorer 1-year DASH scores (3.7, P = 0.0078) and change in DASH scores over the first year (2.9, P = 0.026).
Baseline depression predicts worse function and disability outcomes 1 year from injury. Depression (CES-D ≥16) is the strongest predictor of worse 1-year DASH scores and SF-36 outcome measures, after controlling for other potential predictors.
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
本研究调查55岁以上桡骨远端骨折患者的抑郁情况及预后。
前瞻性数据收集包括患者特征、治疗方式、全身及肢体症状与残疾情况，以及基线、3个月和1年时的并发症。采用双变量分析和多变量线性回归来评估抑郁与预后指标之间的关系，具体指标为简明健康状况调查量表（SF-36）、上肢、肩部和手部功能障碍量表（DASH）评分，以及流行病学研究中心抑郁量表（CES-D）。
本研究在一级创伤中心进行。
招募了所有55岁以上孤立性桡骨远端骨折患者（2007 - 2011年）。
患者接受手术或非手术治疗。
SF-36和DASH评分用于评估全身及上肢状况。使用CES-D量表测量抑郁情况。记录所有并发症。
228例患者中, 25%在基线时存在抑郁，3个月时为32%，1年后为26%。32例患者（14%）出现并发症。基线时的抑郁与并发症之间无关联；然而，在3个月时存在统计学显著关联（P = 0.021）。基线抑郁与1年时较差的SF-36之间存在统计学显著关联。基线时有抑郁的患者1年时的DASH评分（20±2.3）比无抑郁的患者（11±1.3）差（P = 0.0031），且在第一年中DASH评分的改善程度较小（P = 0.023）。多变量线性回归表明，基线抑郁是1年时较差DASH评分（3.7，P = 0.0078）和第一年中DASH评分变化（2.9，P = 0.026）的最强预测因素。
基线抑郁预示着受伤1年后功能和残疾预后较差。在控制其他潜在预测因素后，抑郁（CES-D≥１６）是1年时较差DASH评分和SF-36结局指标的最强预测因素。
预后I级。有关证据水平的完整描述，请参阅作者指南。
