Crijns Tom J, Bernstein David N, Ring David, Gonzalez Ronald M, Wilbur Danielle M, Hammert Warren C
The University of Texas at Austin, USA.
University of Rochester, NY, USA.
Hand (N Y). 2019 Nov;14(6):830-835. doi: 10.1177/1558944718777814. Epub 2018 May 28.
Patient-reported outcome measures vary more than expected based on underlying pathology, in part due to the substantial influence of mood and coping strategies. This study addressed the primary null hypothesis that the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function score 1 month (range, 3-8 weeks) after hand surgery is not associated with PROMIS Depression and PROMIS Pain Interference scores prior to surgery, accounting for other factors. Using an institution-wide database of routinely collected patient-reported outcomes, we identified adult patients who underwent wrist ganglion excision, trapeziometacarpal arthroplasty, hand ganglion excision, trigger digit, De Quervain, and carpal tunnel release. Measures collected included the PROMIS Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We sought factors associated with postsurgical PROMIS Physical Function scores and change between preoperative and postoperative score using multivariable linear regression, accounting for age, sex, surgery type, provider, and time from surgery to postsurgical measurement. Higher postoperative PROMIS Physical Function score was independently associated with lower PROMIS Pain Interference scores, lower PROMIS Depression scores, younger age, and treatment by provider team 3. Greater change in PROMIS Physical Function score was independently associated with greater PROMIS Pain Interference scores, greater time from surgery, and treatment by provider team 3. Mood and effective coping strategies affect the level of symptoms and limitations during recovery from hand surgery and represent important treatment opportunities for enhancing recovery.
患者报告的结局指标因潜在病理状况而异，其差异超出预期，部分原因是情绪和应对策略的重大影响。本研究针对主要的零假设，即手部手术后1个月（范围为3 - 8周）的患者报告结局测量信息系统（PROMIS）身体功能评分与手术前的PROMIS抑郁评分和PROMIS疼痛干扰评分无关，并考虑了其他因素。利用机构范围内常规收集的患者报告结局数据库，我们确定了接受腕部腱鞘囊肿切除术、大多角骨掌骨关节成形术、手部腱鞘囊肿切除术、扳机指松解术、桡骨茎突狭窄性腱鞘炎松解术和腕管松解术的成年患者。收集的测量指标包括PROMIS身体功能计算机自适应测试（CAT）、PROMIS疼痛干扰CAT和PROMIS抑郁CAT。我们使用多变量线性回归，考虑年龄、性别、手术类型、医疗服务提供者以及从手术到术后测量的时间，寻找与术后PROMIS身体功能评分以及术前和术后评分变化相关的因素。术后较高的PROMIS身体功能评分与较低的PROMIS疼痛干扰评分、较低的PROMIS抑郁评分、较年轻的年龄以及由医疗服务提供者团队3进行治疗独立相关。PROMIS身体功能评分的更大变化与更高的PROMIS疼痛干扰评分、更长的手术时间以及由医疗服务提供者团队3进行治疗独立相关。情绪和有效的应对策略会影响手部手术后恢复期间的症状水平和功能受限情况，是促进恢复的重要治疗机会。
