Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
University Medical Center Utrecht, Utrecht, The Netherlands.
J Shoulder Elbow Surg. 2019 Aug;28(8):1431-1440. doi: 10.1016/j.jse.2019.04.045.
The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury.
We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R, correlation matrices, and variable inflation factor assessment.
There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points.
Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.
本研究旨在从一周内和受伤后 2-4 周内测量的一系列人口统计学、损伤、心理和社会变量中，确定与成人肘部骨折后 6-9 个月通过患者报告的结局测量（PROM）测量的功能受限相关的因素。
我们招募了 191 名成年患者，他们患有孤立性肘部骨折，并邀请他们在骨科门诊就诊时完成 PROM（在骨折后最多 1 周内），在 2-4 周之间以及受伤后 6-9 个月之间完成最终评估。进行了双变量分析，然后进行了多变量回归分析，以解释多重共线性。这是通过使用部分 R、相关矩阵和变量膨胀因子评估来评估的。
在受伤后一周内和 2-4 周内，存在多个变量与受伤后 6-9 个月的 PROM 之间存在相关性。受伤后一周内测量的运动恐惧和受伤后 2-4 周内测量的自我效能感是多变量回归中受伤后 6-9 个月功能受限的最强预测因素。回归模型在两个时间点均解释了所有 PROM 的大量差异。
在受伤后一个月内，制定有效的应对策略以克服与运动和再损伤相关的恐惧，并找到在疼痛情况下坚持活动的方法，可能会增强肘部骨折后的康复。使用基于证据的行为治疗可以改变对运动的恐惧和应对能力不佳的情况。
