伴有和不伴有中度至高度抑郁症状的踝关节骨折患者手术治疗后的临床改善：一项使用患者报告结果测量信息系统（PROMIS）的分析
Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS.
作者信息
Bernstein David N, Ramirez Gabriel, Thirukumaran Caroline P, Samuel Flemister A, Oh Irvin C, Ketz John P, Baumhauer Judith F
机构信息
Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA.
Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA.
出版信息
Foot Ankle Orthop. 2023 Jan 20;8(1):24730114221151077. doi: 10.1177/24730114221151077. eCollection 2023 Jan.
BACKGROUND
Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms.
METHODS
From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used.
RESULTS
A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, < .001), PI (β: -10.30, 95% CI: -11.87 to -8.72, < .001), and Depression (β: -5.60, 95% CI: -7.01 to -4.20, < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: -4.00, 95% CI: -7.00 to -1.00, = .01) and PI (β: 3.16, 95% CI: -0.55 to 5.76, = .02) scores.
CONCLUSION
Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms.
LEVEL OF EVIDENCE
Level III, case-control study.
背景
了解踝关节骨折手术治疗后的恢复轨迹有助于外科医生引导患者形成合理预期。此外，考虑心理健康对恢复轨迹的影响也很有益。我们的研究旨在解决现有文献中关于了解踝关节骨折手术后恢复轨迹的不足，包括有抑郁症状的患者。
方法
2015年2月至2020年3月，孤立性踝关节骨折患者在就诊和随访时间点被要求完成患者报告结局测量信息系统（PROMIS）的身体功能（PF）、疼痛干扰（PI）和抑郁问卷，作为常规护理的一部分。使用线性混合效应回归模型评估患者的恢复模式，将所有患者术前时间点与术后<3个月、3 - 6个月和>6个月进行比较。然后使用将抑郁症状作为协变量纳入的额外模型。
结果
共有153例患者符合纳入标准。到3 - 6个月时，PROMIS PF（β：9.95，95%CI：7.97 - 11.94，<0.001）、PI（β： - 10.30，95%CI： - 11.87至 - 8.72，<0.001）和抑郁（β： - 5.60，95%CI： - 7.01至 - 4.20，<0.001）相对于术前时间点有所改善。此后这种恢复水平得以维持。当将抑郁症状作为协变量纳入我们的模型时，中度至高度抑郁症状与PROMIS PF（β： - 4.00，95%CI： - 7.00至 - 1.00，P = 0.01）和PI（β：3.16，95%CI： - 0.55至5.76，P = 0.02）得分显著且具有临床意义的更差情况相关。
结论
踝关节骨折手术后，所有患者在术后3 - 6个月临床症状往往会改善，然后继续保持这种临床改善。尽管中度至高度抑郁症状的患者在相同轨迹下临床症状也会改善，但他们改善的程度往往低于抑郁症状较轻的患者。
证据水平
III级，病例对照研究。
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