Stewart Julian A, Aebischer Vera, Egloff Niklaus, Wegmann Barbara, von Känel Roland, Vögelin Esther, Grosse Holtforth Martin
Division of Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, 3010, Bern, Switzerland.
Department of Psychology, University of Bern, Bern, Switzerland.
Int J Behav Med. 2018 Jun;25(3):374-379. doi: 10.1007/s12529-018-9713-4.
Psychological factors have shown to be associated with treatment outcomes in hand injury patients. This study aimed to investigate the role of health locus of control (HLOC) and its dimensions internal, social-external, and fatalistic-external HLOC in treatment outcomes of hand injury patients.
One hundred thirty-two consecutive patients of a tertiary center for hand surgery undergoing treatment for acute hand injury or degenerative hand problems were included in this study. Pretreatment levels of depression, anxiety, HLOC, and pain intensity were measured, along with pain intensity levels at 4-month follow-up. Hierarchical regression analyses were calculated to test for moderation effects of the HLOC dimensions on the relationship between pretreatment and follow-up pain intensity.
Controlling for age, gender, treatment modality, source of hand pain, and depressive symptoms, a moderation effect emerged (β = - 0.16, p < 0.05), such that among patients higher in initial pain intensity, those lower in social-external HLOC experienced higher pain intensity at follow-up compared to those with high social-external HLOC. Internal HLOC and fatalistic-external HLOC did not moderate the effect of initial pain intensity on pain intensity at follow-up.
Hand injury patients suffering greater initial pain intensity who also had lower versus higher social-external HLOC experienced less favorable treatment outcome. This finding suggests that if patients with high initial pain succeed in transferring perceived health control to professionals and to gain confidence in treatment and clinicians, treatment outcome could be improved in hand surgery.
心理因素已被证明与手部损伤患者的治疗结果相关。本研究旨在探讨健康控制点（HLOC）及其维度——内在、社会外在和宿命外在HLOC在手部损伤患者治疗结果中的作用。
本研究纳入了一家三级手部外科中心连续接受急性手部损伤或退行性手部问题治疗的132名患者。测量了治疗前的抑郁、焦虑、HLOC和疼痛强度水平，以及4个月随访时的疼痛强度水平。进行分层回归分析以检验HLOC维度对治疗前和随访疼痛强度之间关系的调节作用。
在控制了年龄、性别、治疗方式、手部疼痛来源和抑郁症状后，出现了调节效应（β = -0.16，p < 0.05），即在初始疼痛强度较高的患者中，社会外在HLOC较低的患者在随访时的疼痛强度高于社会外在HLOC较高的患者。内在HLOC和宿命外在HLOC并未调节初始疼痛强度对随访时疼痛强度的影响。
初始疼痛强度较大且社会外在HLOC较低的手部损伤患者与社会外在HLOC较高的患者相比，治疗结果较差。这一发现表明，如果初始疼痛程度高的患者成功地将感知到的健康控制权转移给专业人员并对治疗和临床医生建立信心，手部手术的治疗结果可能会得到改善。
