Hooker Julia E, Jochimsen Kate N, Mace Ryan A, Doorley James D, Brewer Julie R, Vranceanu Ana-Maria
Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Arch Bone Jt Surg. 2024;12(12):826-834. doi: 10.22038/ABJS.2024.76953.3559.
Traumatic orthopedic injuries are a top cause of hospital visits in the U.S. The Toolkit for Optimal Recovery (TOR) is a brief mind-body intervention that targets catastrophic thinking and pain anxiety following orthopedic injury. This study examines the baseline presentation of adults with traumatic orthopedic injuries who were enrolled in our recent multisite feasibility RCT of TOR versus usual care at four geographically distinct Level 1 trauma centers. We also examine whether patient presentation varies by site.
We recruited 181 adults (M=44.16, SD=16.5) from four Level I trauma centers located in the northeast (Site A; =63), southwest (Site B; =44), southeast (Site C; =44), and southeast (Site D; =30). At baseline, participants provided information about sociodemographic factors, pain and physical function, and physicians completed the Abbreviated Injury Scale (AIS). Descriptive statistics were used to characterize the sample, and one-way analysis of variance (ANOVA) and Chi-square tests were used to compare variables between sites.
The majority of the sample (88.4%) sustained a fracture, and the mean AIS score was 2.31 (=0.55). Age, race, sex, gender, occupation, or marital status did not differ across sites (>.05). Over half (63%) of the sample was treated surgically, and 28.7% endorsed taking narcotic pain medications. More participants at Sites B (75%) and D (96.7%) received surgery than participants at Sites A (41%) and C (61.4%). More participants at Sites D and B reported narcotic usage than participants at Sites C and A. Participants at Site D demonstrated greater functional impairment than participants at the other sites.
Although sites were largely comparable, we did find key differences in surgical management, narcotic use, and functional disability which may have important implications for treatment response. This information will be used to iterate and refine TOR for a future multisite efficacy trial.
创伤性骨科损伤是美国医院就诊的主要原因之一。最佳恢复工具包（TOR）是一种简短的身心干预措施，旨在针对骨科损伤后的灾难性思维和疼痛焦虑。本研究调查了在我们最近进行的一项多中心可行性随机对照试验中，在四个地理位置不同的一级创伤中心参与TOR与常规护理对比研究的创伤性骨科损伤成人患者的基线表现。我们还研究了患者表现是否因中心而异。
我们从位于东北部（A中心；n = 63）、西南部（B中心；n = 44）、东南部（C中心；n = 44）和东南部（D中心；n = 30）的四个一级创伤中心招募了181名成年人（M = 44.16，SD = 16.5）。在基线时，参与者提供了社会人口学因素、疼痛和身体功能方面的信息，医生完成了简明损伤定级标准（AIS）。描述性统计用于描述样本特征，单因素方差分析（ANOVA）和卡方检验用于比较各中心之间的变量。
大多数样本（88.4%）发生了骨折，平均AIS评分为2.31（= 0.55）。各中心在年龄、种族、性别、职业或婚姻状况方面没有差异（> 0.05）。超过一半（63%）的样本接受了手术治疗，28.7%的人认可服用麻醉性止痛药。与A中心（41%）和C中心（61.4%）的参与者相比，B中心（75%）和D中心（96.7%）接受手术的参与者更多。与C中心和A中心的参与者相比，D中心和B中心报告使用麻醉剂的参与者更多。D中心的参与者比其他中心的参与者表现出更大的功能障碍。
尽管各中心在很大程度上具有可比性，但我们确实发现了手术管理、麻醉剂使用和功能残疾方面的关键差异，这些差异可能对治疗反应具有重要意义。这些信息将用于完善TOR，以便未来进行多中心疗效试验。
