Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Clin Orthop Relat Res. 2022 May 1;480(5):960-968. doi: 10.1097/CORR.0000000000002057. Epub 2021 Dec 2.
It has been observed that patients with carpal tunnel syndrome (CTS) who also experience emotional distress, depression, or anxiety report more severe symptoms. As patients' own perspectives about their health increasingly are guiding treatment decisions, it seems important to study the simultaneous association of psychological distress and neuropathology with hand disability in patients who have CTS, as this may help prioritize and sequence management steps.
QUESTIONS/PURPOSES: What are the relationships among validated scores for (1) depression, (2) anxiety, (3) pain catastrophizing, and (4) nerve electrodiagnostic severity with measures of hand disability in patients with confirmed CTS?
Between 2017 and 2019, we evaluated 116 patients for CTS in a referral urban hospital in Mashhad, Iran. Of those, we considered 85% (99) as potentially eligible by considering the following Electromyography-Nerve Conduction Study (EMG-NCS) diagnostic criteria: sensory latency ≥ 3.5 Ms, median-ulnar latency difference ≥ 0.5 Ms, motor latency ≥ 4.2 Ms, and abnormal EMG findings in the opponens pollicis muscle (neurogenic motor unit action potentials, positive sharp waves, or fibrillation). A further 13% (15 of 116) were excluded because of nonidiopathic CTS and prior surgery, and another 12% (14 of 116) were lost because of incomplete datasets, leaving 60% (70 of 116) for final inclusion in this cross-sectional study. In all, 89% of patients were women with total mean age of 47 years. We measured depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) questionnaire (scored from 0 to 21, with a minimum clinically important difference [MCID] of 1.7 points), and we evaluated patients' state of mind regarding pain using the Pain Catastrophizing Scale (PCS) (scored from 0 to 52). Higher scores on these questionnaires represent more distress and pain catastrophizing. Hand disability was assessed with Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire outcomes (scored from 0 [no disability] to 100 [most severe disability]; MCID of 15 points), Likert pain score (from 0 to 10), and grip/pinch dynamometry results. Correlational analyses were conducted once among HADS and PCS scores and again among EMG-NCS indices with pain and disability variables to answer our first, third, and fourth questions, respectively. Regression analysis was performed to assess the percentage of variance in QuickDASH and pain severity, which could be explained by psychological and electrodiagnostic factors. We did not include grip and pinch in our multivariable model (regression analysis) as dependent variables because they did not correlate with any of psychological or EMG-NCS variables (all p values > 0.1). Significance was set at p < 0.05.
Correlational analysis showed that the scores of all three psychological questionnaires correlated with the QuickDASH score (r = 0.50, 0.42, and 0.53 for HADS-A, HADS-D, and PCS, respectively; p < 0.001 for all three), while EMG-NCS parameters had no correlation with QuickDASH and pain scores. We also found that 37% of the variance in QuickDASH score can be explained by HADS and PCS scores (r2 = 0.37; p < 0.001).
Evaluation and treatment of psychological distress before deciding on elective surgery for CTS is important because patient-reported disability-often used as a factor in surgical decision-making-is substantially correlated with emotional distress. Future prospective, controlled studies on this topic are recommended; ideally, these should evaluate psychological interventions specifically to ascertain whether they improve patients' ratings of hand disability.
Level III, prognostic study.
患有腕管综合征 (CTS) 并同时经历情绪困扰、抑郁或焦虑的患者报告的症状更为严重。由于患者对自身健康的看法越来越多地指导着治疗决策，因此研究心理困扰和神经病理学与 CTS 患者手部残疾的同时关联似乎很重要，因为这有助于确定管理步骤的优先级和顺序。
问题/目的：在确认患有 CTS 的患者中，验证的（1）抑郁、（2）焦虑、（3）疼痛灾难化和（4）神经电诊断严重程度评分与手部残疾测量之间存在哪些关系？
在 2017 年至 2019 年间，我们在伊朗马什哈德的一家转诊城市医院对 116 名患者进行了 CTS 评估。其中，我们考虑了 85%（99 人）可能符合以下肌电图-神经传导研究 (EMG-NCS) 诊断标准：感觉潜伏期≥3.5ms，正中神经-尺神经潜伏期差异≥0.5ms，运动潜伏期≥4.2ms，以及在对掌肌中发现异常的肌电图表现（神经源性运动单位动作电位、正锐波或纤颤）。另有 13%（116 人中有 15 人）因非特发性 CTS 和先前手术而被排除在外，另有 12%（116 人中有 14 人）因数据集不完整而丢失，最终有 60%（70 人中有 70 人）纳入本横断面研究。所有患者中 89%为女性，平均年龄为 47 岁。我们使用医院焦虑和抑郁量表 (HADS) 问卷（评分范围为 0 至 21，最小临床重要差异 [MCID] 为 1.7 分）测量抑郁和焦虑，使用疼痛灾难化量表 (PCS)（评分范围为 0 至 52）评估患者的心态。问卷得分越高表示困扰和疼痛灾难化越严重。使用快速上肢、肩部和手部残疾问卷 (QuickDASH) 问卷结果（评分范围为 0 [无残疾] 至 100 [最严重残疾]；MCID 为 15 分）、Likert 疼痛评分（0 至 10）和握力/捏力测力计结果评估手部残疾。我们进行了一次相关性分析，将 HADS 和 PCS 评分之间以及再次在 EMG-NCS 指数与疼痛和残疾变量之间进行相关性分析，分别回答我们的第一、第三和第四个问题。进行回归分析以评估 QuickDASH 和疼痛严重程度的可解释方差百分比，这些可由心理和电诊断因素解释。我们没有将握力和捏力纳入我们的多变量模型（回归分析）作为因变量，因为它们与任何心理或 EMG-NCS 变量均无相关性（所有 p 值均>0.1）。设 p<0.05 为显著性水平。
相关性分析表明，所有三个心理问卷的评分均与 QuickDASH 评分相关（HADS-A、HADS-D 和 PCS 的 r 值分别为 0.50、0.42 和 0.53；均 p<0.001），而 EMG-NCS 参数与 QuickDASH 和疼痛评分均无相关性。我们还发现，HADS 和 PCS 评分可以解释 QuickDASH 评分变化的 37%（r2=0.37；p<0.001）。
在决定对 CTS 进行择期手术之前评估心理困扰很重要，因为患者报告的残疾——通常作为手术决策的一个因素——与情绪困扰密切相关。建议对此主题进行前瞻性、对照研究；理想情况下，这些研究应评估心理干预措施，以确定它们是否能改善患者的手部残疾评级。
III 级，预后研究。
