Kazmers Nikolas H, Hung Man, Rane Ajinkya A, Bounsanga Jerry, Weng Cindy, Tyser Andrew R
Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Department of Orthopaedics, University of Utah, Salt Lake City, UT; Division of Public Health, University of Utah, Salt Lake City, UT.
J Hand Surg Am. 2017 Oct;42(10):781-787. doi: 10.1016/j.jhsa.2017.05.008. Epub 2017 Sep 9.
The relationship between psychosocial factors and self-reported physical function among hand and upper extremity patients is complex. The Patient-Reported Outcomes Measurement Information System (PROMIS) platform has attempted to create a variety of specifically targeted metrics that can be administered using computer adaptive testing (CAT). Three metrics measuring self-reported physical function (herein referred to in combination as "functional" metrics) include the PROMIS Physical Function (PF) CAT, PROMIS Upper Extremity (UE) CAT, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Two metrics assessing psychosocial factors include the PROMIS Anxiety and Pain Interference (PI) CATs ("nonfunctional" metrics). This study evaluates whether the functional metrics were correlated with nonfunctional metrics.
The 5 questionnaires were administered prospectively on a tablet computer to all consecutive adult patients presenting to an outpatient hand and upper extremity (nonshoulder) clinic at a tertiary academic medical center from January 1 to November 1, 2014. For patients with multiple visits during the study period, only the first was included. Data were evaluated retrospectively to assess the relationship between functional and nonfunctional measures, with Pearson correlation coefficients to understand the relationship between continuous variables, and 1-way analysis of variance to examine for differences in outcome measures across demographic groups. Multivariable linear regression analyses were performed to determine factors predicting functional disability.
We included 1,299 patients: mean age was 46.8 years, 53% were female, and 23% were unemployed or on disability. The PROMIS PF CAT, PROMIS UE CAT, and QuickDASH scores were all significantly correlated with PROMIS Anxiety CAT (Pearson correlation coefficients, -0.46, -0.48, and 0.53, respectively) and PROMIS PI CAT (-0.60, -0.65, and 0.76, respectively) scores. Multivariable regression analyses demonstrated that increased PROMIS Anxiety and PI CAT scores each independently and adversely influenced PROMIS PF CAT, PROMIS UE CAT, and QuickDASH scores.
Increasing levels of patient anxiety and pain interference are independently associated with decreased patient-reported upper extremity function.
This study provides further support of the biopsychosocial model by highlighting that increased anxiety is associated with decreased self-reported function using the PROMIS platform.
心理社会因素与手部及上肢疾病患者自我报告的身体功能之间的关系较为复杂。患者报告结局测量信息系统（PROMIS）平台试图创建各种专门针对的指标，这些指标可通过计算机自适应测试（CAT）进行管理。三个测量自我报告身体功能的指标（在此统称为“功能”指标）包括PROMIS身体功能（PF）CAT、PROMIS上肢（UE）CAT以及手臂、肩部和手部快速残疾评估量表（QuickDASH）。两个评估心理社会因素的指标包括PROMIS焦虑和疼痛干扰（PI）CAT（“非功能”指标）。本研究评估功能指标与非功能指标是否相关。
2014年1月1日至11月1日期间，在一家三级学术医疗中心的门诊手部及上肢（非肩部）诊所，对所有连续就诊的成年患者前瞻性地在平板电脑上进行这5份问卷的调查。对于在研究期间多次就诊的患者，仅纳入首次就诊的数据。对数据进行回顾性评估，以评估功能指标与非功能指标之间的关系，使用Pearson相关系数来了解连续变量之间的关系，并进行单因素方差分析以检验不同人口统计学组间结局指标的差异。进行多变量线性回归分析以确定预测功能残疾的因素。
我们纳入了1299例患者：平均年龄为46.8岁，53%为女性，23%失业或领取残疾补助。PROMIS PF CAT、PROMIS UE CAT和QuickDASH评分均与PROMIS焦虑CAT（Pearson相关系数分别为-0.46、-0.48和0.53）和PROMIS PI CAT（分别为-0.60、-0.65和0.76）评分显著相关。多变量回归分析表明，PROMIS焦虑和PI CAT评分的增加均独立且不利地影响PROMIS PF CAT、PROMIS UE CAT和QuickDASH评分。
患者焦虑和疼痛干扰水平的升高与患者报告的上肢功能下降独立相关。
本研究通过强调使用PROMIS平台时焦虑增加与自我报告功能下降相关，进一步支持了生物心理社会模型。
