Looman Rick S, Oude Nijhuis Koen D, Ramtin Sina, Ring David, London Daniel A, Calfee Ryan, Brinkman Niels
Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States of America.
Department of Orthopaedic Surgery, University Medical Centre Groningen and Groningen University, Groningen, the Netherlands.
PLoS One. 2025 Sep 12;20(9):e0332221. doi: 10.1371/journal.pone.0332221. eCollection 2025.
Measures that quantify levels of pain intensity, incapability, symptoms of distress, and unhelpful thinking were designed as research tools. We studied how surgeons interpret and act on these scores in the care of individual patients.
In an online experiment, 67 upper limb specialists from the Science of Variation Group reviewed 10 fictious patient scenarios of trapeziometacarpal, wrist and elbow osteoarthritis (OA) and randomized elements of radiographic severity, levels of discomfort and incapability, deprivation index score (social health), and levels of distress and unhelpful thinking (mental health). Multilevel mixed-effects linear regression identified patient factors associated with surgeon concern, enthusiasm to offer surgery, motivation to discuss mental health and social circumstances, and likelihood to refer for mental/social health care.
Higher levels of discomfort, incapability, distress, unhelpful thinking, and deprivation were associated with greater surgeon concern, increased motivation to discuss or refer for mental and social health, and greater motivation to refer for mental/social health. Greater likelihood to offer surgery was associated with greater discomfort and incapability, greater radiographic severity, wrist and elbow OA, and greater distress/unhelpful thinking.
Measures that quantify the subjective aspects of illness draw surgeon attention to mental and social health, and can be used to inform comprehensive, biopsychosocial diagnostic and treatment strategies.
旨在设计量化疼痛强度、功能丧失、痛苦症状及无益思维水平的测量方法作为研究工具。我们研究了外科医生在照顾个体患者时如何解读这些评分并据此采取行动。
在一项在线实验中，来自变异科学小组的67名上肢专科医生审阅了10个关于大多角骨掌指关节、腕关节和肘关节骨关节炎（OA）的虚拟患者病例，并对影像学严重程度、不适和功能丧失水平、剥夺指数评分（社会健康）以及痛苦和无益思维水平（心理健康）等因素进行了随机设定。多级混合效应线性回归确定了与外科医生的关注、提供手术的积极性、讨论心理健康和社会状况的动机以及转介至精神/社会医疗保健机构可能性相关的患者因素。
更高水平的不适、功能丧失、痛苦、无益思维和剥夺与外科医生更大的关注、讨论或转介至精神和社会医疗保健机构的更强动机以及转介至精神/社会医疗保健机构的更强动机相关。提供手术的更大可能性与更高水平的不适和功能丧失、更高的影像学严重程度、腕关节和肘关节OA以及更高水平的痛苦/无益思维相关。
量化疾病主观方面的测量方法能引起外科医生对精神和社会健康的关注，并可用于为全面的生物心理社会诊断和治疗策略提供信息。
