Ottenhoff Janna S E, Ring David, Molen Aebele B Mink van der, Coert J Henk, Teunis Teun
Plastic, Reconstructive, and Hand Surgery Department, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, United States.
J Hand Microsurg. 2022 Jun 10;14(4):315-321. doi: 10.1055/s-0042-1748879. eCollection 2022 Oct.
There is notable evidence that unhelpful thoughts (symptoms of anxiety and depression) increase symptom intensity among patients with trapeziometacarpal osteoarthritis (TMC OA). Surgeons may or may not be mindful of this line of evidence when interacting with patients. In a survey-based experiment, we randomized surgeons to be prompted about the psychosocial aspects of TMC OA. We aimed to measure the influence of mindfulness of mental health on treatment recommendations and willingness to discuss mental health interventions. We randomized 121 hand surgeons to read one of two paragraphs: (A) about biomedical treatment options for TMC OA, or (B) about the impact of mental and social aspects on TMC OA. Thereafter, surgeons were asked several questions about their opinions and treatment recommendations. We found that prompting surgeons with information about the psychosocial aspects of TMC OA did not influence their attitudes or treatment recommendations. Most surgeons were willing to offer patients a workbook (92%) or psychologist referral (84%). Among the few surgeons declining to refer, their reasoning was "it would not be of any help" and "stigmatization." The observation that a paragraph to encourage mindfulness about the psychosocial aspects of TMC OA, which had no influence on surgeon opinions, suggests that awareness may not be a major factor accounting the relatively limited implementation of this evidence in practice to date. Surgeons seem aware of the importance of psychological influence and barriers may include availability, stigma, and a sense of futility. This is a diagnostic study that reflects level of evidence III.
有显著证据表明，无益思维（焦虑和抑郁症状）会增加第一掌腕关节骨关节炎（TMC OA）患者的症状强度。外科医生在与患者互动时，可能会也可能不会留意到这一系列证据。在一项基于调查的实验中，我们将外科医生随机分组，一组会收到有关TMC OA心理社会方面的提示。我们旨在衡量对心理健康的关注对治疗建议以及讨论心理健康干预措施意愿的影响。
我们将121名手外科医生随机分组，让他们阅读两段文字中的一段：（A）关于TMC OA的生物医学治疗选择，或（B）关于心理和社会方面对TMC OA的影响。此后，向外科医生询问了几个关于他们的意见和治疗建议的问题。
我们发现，向外科医生提供有关TMC OA心理社会方面的信息，并不会影响他们的态度或治疗建议。大多数外科医生愿意为患者提供一本工作手册（92%）或转介给心理医生（84%）。在少数拒绝转介的外科医生中，他们的理由是“这没有任何帮助”和“污名化”。
观察结果表明，一段鼓励关注TMC OA心理社会方面的文字，对外科医生的意见没有影响，这表明意识可能不是迄今为止该证据在实践中实施相对有限的主要因素。外科医生似乎意识到了心理影响的重要性，障碍可能包括可及性、污名化和无用感。这是一项反映证据水平为III级的诊断性研究。
