de Ridder Willemijn A, van der Oest Mark J W, Slijper Harm P, Vermeulen Guus M, Hovius Steven E R, Selles Ruud W, Wouters Robbert M
Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands; Center for Hand Therapy, Xpert Handtherapie, Eindhoven, the Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, Eindhoven, the Netherlands.
J Psychosom Res. 2023 Nov;174:111094. doi: 10.1016/j.jpsychores.2022.111094. Epub 2022 Nov 21.
Baseline mindset factors are important factors that influence treatment decisions and outcomes. Theoretically, improving the mindset prior to treatment may improve treatment decisions and outcomes. This prospective cohort study evaluated changes in patients' mindset following hand surgeon consultation. Additionally, we assessed if the change in illness perception differed between surgical and nonsurgical patients.
The primary outcome was illness perception, measured using the total score of the Brief Illness Perception Questionnaire (B-IPQ, range 0-80). Secondary outcomes were the B-IPQ subscales, pain catastrophizing (measured using the Pain Catastrophizing Scale (PCS)), and psychological distress (measured using the Patient Health Questionnaire-4).
A total of 276 patients with various hand and wrist conditions completed the mindset questionnaires before and after hand surgeon consultation (median time interval: 15 days). The B-IPQ total score improved from 39.7 (±10.6) before to 35.8 (±11.3) after consultation (p < 0.0001, Cohen's d = 0.36); scores also improved for the B-IPQ subscales Coherence, Concern, Emotional Response, Timeline, Treatment Control, and Identity and the PCS. There were no changes in the other outcomes. Surgical patients improved on the B-IPQ subscales Treatment Control and Timeline, while nonsurgical patients did not.
Illness perception and pain catastrophizing improved following hand surgeon consultation, suggesting that clinicians may actively influence the patients' mindset during consultations, and that they may try to enhance this effect to improve outcomes. Furthermore, surgical patients improved more in illness perceptions, indicating that nonsurgical patients may benefit from a more targeted strategy for changing mindset.
基线思维模式因素是影响治疗决策和结果的重要因素。从理论上讲，在治疗前改善思维模式可能会改善治疗决策和结果。这项前瞻性队列研究评估了手外科会诊后患者思维模式的变化。此外，我们还评估了手术患者和非手术患者在疾病认知变化方面是否存在差异。
主要结局指标为疾病认知，采用简明疾病认知问卷（B-IPQ，范围0-80）总分进行测量。次要结局指标为B-IPQ子量表、疼痛灾难化（采用疼痛灾难化量表（PCS）测量）和心理困扰（采用患者健康问卷-4测量）。
共有276例患有各种手部和腕部疾病的患者在接受手外科会诊前后完成了思维模式问卷（中位时间间隔：15天）。B-IPQ总分从会诊前的39.7（±10.6）提高到会诊后的35.8（±11.3）（p<0.0001，科恩d值=0.36）；B-IPQ子量表连贯性、关注度、情绪反应、时间线、治疗控制、身份认同以及PCS的得分也有所提高。其他结局指标无变化。手术患者在B-IPQ子量表治疗控制和时间线方面有所改善，而非手术患者则没有。
手外科会诊后疾病认知和疼痛灾难化得到改善，这表明临床医生在会诊期间可能会积极影响患者的思维模式，并且他们可能会试图增强这种效果以改善治疗结果。此外，手术患者在疾病认知方面改善更多，这表明非手术患者可能会从更有针对性的思维模式改变策略中受益。
