Wilkens Suzanne C, Menendez Mariano E, Ring David, Chen Neal
1 Massachusetts General Hospital, Boston, USA.
2 Dell Medical School, Austin, TX, USA.
Hand (N Y). 2017 Sep;12(5):461-466. doi: 10.1177/1558944716677937. Epub 2016 Nov 9.
Trapeziometacarpal (TMC) arthrosis has a variety of treatment options, including nonoperative (eg, education, splint, injection) and operative management. Symptoms and limitations vary greatly among patients. The purpose of this study was to determine an association of symptoms and limitations, quantified using the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, with treatment choice in patients newly diagnosed with TMC arthrosis. We also addressed the association of the QuickDASH score with radiographic severity and sought factors associated with higher QuickDASH scores.
As part of the routine new patient intake paperwork, all new patients completed a QuickDASH form. We included 81 new patients with newly diagnosed TMC arthrosis visiting the office of 1 of 5 orthopedic hand surgeons between March 1, 2015, and November 30, 2015. Eight patients were excluded because of incomplete QuickDASH forms.
Based on QuickDASH tertiles, patients with a low QuickDASH score were more likely to choose education alone than patients with intermediate and high QuickDASH scores; no patients in the lowest QuickDASH tertile chose injection or surgery. Patients who chose education alone also had a lower mean QuickDASH score than patients who chose splint or surgery. Radiographic severity and other patient-related factors were not associated with greater symptoms and limitations.
More adaptive patients (lower QuickDASH) are less likely to choose injection or surgery, irrespective of disease severity. The psychosocial factors known to correlate with greater symptoms and limitations might lead patients to feel they have fewer options or to choose more interventional options than they would if they were more at ease. In other words, inadequate attention to psychosocial factors may increase the risk of misdiagnosis of patient preferences.
大多角骨-第一掌骨关节（TMC）关节病有多种治疗选择，包括非手术治疗（如教育、夹板固定、注射）和手术治疗。患者的症状和功能受限情况差异很大。本研究的目的是确定使用手臂、肩部和手部功能障碍（QuickDASH）评分量化的症状和功能受限与新诊断为TMC关节病患者的治疗选择之间的关联。我们还探讨了QuickDASH评分与影像学严重程度之间的关联，并寻找与较高QuickDASH评分相关的因素。
作为常规新患者入院文书工作的一部分，所有新患者都填写了一份QuickDASH表格。我们纳入了2015年3月1日至2015年11月30日期间在5位手外科骨科医生之一的办公室就诊的81例新诊断为TMC关节病的患者。8例患者因QuickDASH表格填写不完整而被排除。
根据QuickDASH三分位数，QuickDASH评分低的患者比QuickDASH评分中等和高的患者更有可能仅选择教育治疗；QuickDASH最低三分位数的患者中没有选择注射或手术的。仅选择教育治疗的患者的平均QuickDASH评分也低于选择夹板固定或手术的患者。影像学严重程度和其他患者相关因素与更严重的症状和功能受限无关。
适应性更强的患者（QuickDASH评分较低）无论疾病严重程度如何都不太可能选择注射或手术。已知与更严重症状和功能受限相关的心理社会因素可能导致患者觉得自己的选择较少，或者比他们感觉更轻松时选择更多的介入性治疗。换句话说，对心理社会因素关注不足可能会增加误诊患者偏好的风险。
