Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, TX; and.
J Orthop Trauma. 2024 Oct 1;38(10):557-565. doi: 10.1097/BOT.0000000000002868.
To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures.
Secondary use of longitudinal data.
Single Level-1 trauma center in Oxford, United Kingdom.
English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded.
Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2-4 weeks, and 6-9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects.
Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P < 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P < 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P < 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P < 0.02).
Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定心态和骨折严重程度对上肢骨折后 9 个月疼痛和功能恢复轨迹的相对影响。
纵向数据的二次利用。
英国牛津的单一级创伤中心。
纳入接受手术或非手术治疗的单纯肱骨近端、肘或桡骨远端骨折的英语患者，并排除多发性骨折或认知障碍的患者。
损伤后 2-4 周和 6-9 个月时，采用简明残疾指数（Quick-DASH）和 11 点疼痛评分量表评估功能障碍和疼痛强度。采用聚类分析识别心态（PROMIS 抑郁和焦虑量表、疼痛灾难化量表和 Tampa 运动恐惧量表）和骨折严重程度（根据 OTA/AO 分类为低/中/高）的统计学分组。考虑到各种与骨折相关的因素，评估了每个心态分组的功能障碍和疼痛强度的恢复轨迹。
共纳入 703 例患者（年龄 59±21 岁，66%为女性，16%为高能损伤），确定了 4 个具有递增焦虑和无益思维水平的统计学分组（未考虑骨折严重程度，因为它没有区分作用）。心态更不健康的组，基线功能障碍（组 2：β=4.1，组 3：β=7.5，组 4：β=17）和疼痛强度（组 3：β=0.70，组 4：β=1.4）（P＜0.01）更差。更高的骨折严重程度（β=4.5）、高能损伤（β=4.0）和神经麻痹（β=8.1）与更差的基线功能障碍相关（P＜0.01），而高能损伤（β=0.62）和神经麻痹（β=0.76）与更差的基线疼痛强度相关（P＜0.01）。组 3 和 4 的功能障碍（β=1.3，β=7.0）和疼痛强度（β=0.19，β=1.1）恢复速度较慢（P＜0.02）。
对症状感到无益思维和焦虑程度更高的患者，疼痛和功能障碍恢复更差，其影响大小超过骨折部位、骨折严重程度、高能损伤和神经麻痹。这些发现强调了在受伤康复过程中预测和处理心理健康问题的重要性。
预后 III 级。欲了解完整的证据水平描述，请参见作者指南。
