From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center; the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC; the Hand and Wrist Center, Xpert Clinic; and the Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School.
Plast Reconstr Surg. 2021 Jan 1;147(1):66e-75e. doi: 10.1097/PRS.0000000000007441.
Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing.
A total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities.
Independent associations with better self-reported outcome were found for higher treatment expectations (β = -0.202; p < 0.001) and illness comprehensibility (β = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent).
Treatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
抑郁和疼痛灾难化是患者心态的两个方面，已被证明与腕管松解术的结果有关。然而，患者心态的其他方面尚未得到充分研究，例如治疗期望和疾病认知。本研究旨在调查这些心态方面除心理困扰和疼痛灾难化之外，对腕管松解术结果的影响。
共纳入 307 名患有腕管综合征的患者，他们访问了门诊手外科诊所，并在线完成了有关人口统计学和社会心理特征以及腕管综合征严重程度的问卷。使用患者健康问卷-4、疼痛灾难化量表、可信度期望问卷和简要疾病认知问卷来测量患者心态。使用分层线性回归模型，在校正术前波士顿腕管问卷评分、患者特征和合并症后，检查自报告的腕管松解术后 6 个月的严重程度（用波士顿腕管问卷测量）与心态的社会心理方面之间的关系。
发现治疗期望（β=-0.202；p<0.001）和疾病理解度（β=-0.223；p<0.001）与更好的自我报告结果独立相关。患者心态对波士顿腕管问卷评分的额外解释方差为 13.2%（心理困扰和疼痛灾难化共占 2.1%；治疗期望和疾病认知共占 11.1%）。
治疗期望和疾病认知度都与腕管松解术的结果独立相关，这表明患者心态的这些方面对腕管松解术的结果很重要。
临床问题/证据水平：风险，III。
