Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK.
University Medical Center, Utrecht, The Netherlands.
Bone Joint J. 2019 Jun;101-B(6):715-723. doi: 10.1302/0301-620X.101B6.BJJ-2018-0857.R1.
The purpose of this study was to identify factors associated with limitations in function, measured by patient-reported outcome measures (PROMs), six to nine months after a proximal humeral fracture, from a range of demographic, injury, psychological, and social variables measured within a week and two to four weeks after injury.
We enrolled 177 adult patients who sustained an isolated proximal humeral fracture into the study and invited them to complete PROMs at their initial outpatient visit within one week of injury, between two and four weeks, and between six to nine months after injury. There were 128 women and 49 men; the mean age was 66 years (sd 16; 18 to 95). In all, 173 patients completed the final assessment. Bivariate analysis was performed followed by multivariable regression analysis accounting for multicollinearity using partial R, correlation matrices, and variable inflation factor.
Many variables within a week of injury and between two and four weeks after injury correlated with six- to nine-month PROMs in bivariate analysis. Kinesiophobia measured within a week of injury (Tampa Scale for Kinesiophobia-11: partial R = 0.14; p = 0.000) and self-efficacy measured between two and four weeks (Pain Self-efficacy Questionnaire-2: partial R = 0.266; p < 0.001) were the strongest predictors of limitations (measured by Patient Reported Outcome Measurement Information System Upper Extremity Physical Function Computer Adaptive Test (PROMIS UE)) at six to nine months in multivariable analysis. Similar findings were observed with other types of PROM. Regression models accounted for a substantial amount of variance in all PROMs at both timepoints (e.g. 66% of the overall variance within one week, and 70% within two to four weeks for PROMIS UE at six to nine months).
Recovery from a proximal humeral fracture appears to be enhanced by overcoming fears of movement or reinjury within a week after injury and greater self-efficacy (developing resilience and more effective coping strategies) within a month. Such factors are modifiable using enhanced communication skills and cognitive behavioural treatments. These findings could be a catalyst for the routine assessment and treatment of psychological and social factors in the management of patients with fractures. Cite this article: 2019;101-B:715-723.
本研究旨在从一系列人口统计学、损伤、心理和社会变量中确定与功能受限相关的因素，这些因素通过患者报告的结果测量（PROMs）进行测量，这些功能受限发生在肱骨头骨折后 6 至 9 个月，这些因素是在损伤后一周和 2 至 4 周内测量的。
我们纳入了 177 名成年患者，这些患者均发生了孤立性肱骨头骨折，他们在损伤后一周内的首次门诊就诊时被邀请完成 PROMs，分别在损伤后 2 至 4 周和 6 至 9 个月时进行评估。共有 128 名女性和 49 名男性，平均年龄为 66 岁（标准差 16 岁；18 岁至 95 岁）。共有 173 名患者完成了最终评估。进行了单变量分析，然后使用偏 R、相关矩阵和变量膨胀因子对多元回归分析进行了多变量分析，以考虑共线性。
在单变量分析中，损伤后一周内和 2 至 4 周内的许多变量与 6 至 9 个月时的 PROMs 相关。损伤后一周内测量的运动恐惧（Tampa 运动恐惧量表-11：偏 R = 0.14；p = 0.000）和损伤后 2 至 4 周内测量的自我效能（疼痛自我效能问卷-2：偏 R = 0.266；p < 0.001）是 6 至 9 个月时多变量分析中限制（用患者报告的结果测量信息系统上肢物理功能计算机自适应测试（PROMIS UE）测量）的最强预测因子。在多变量分析中，使用其他类型的 PROM 也观察到了类似的发现。回归模型在两个时间点都能很好地解释所有 PROM 的大部分方差（例如，在一周内解释了整体方差的 66%，在 2 至 4 周内解释了 PROMIS UE 的 70%）。
在损伤后一周内克服对运动或再损伤的恐惧，以及在一个月内提高自我效能（培养韧性和更有效的应对策略），似乎可以促进肱骨头骨折的恢复。这些因素可以通过增强沟通技巧和认知行为治疗来改变。这些发现可能会促使人们在骨折患者的管理中常规评估和治疗心理和社会因素。引用本文：2019；101-B：715-723.
