Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review

A Web-Based Mind-Body Intervention to Improve Resilience Among Patients With Nontraumatic Painful Upper-Extremity Conditions and Comorbid Risky Substance Use: Protocol for a Mixed Methods Study

BACKGROUND

Nontraumatic painful upper-extremity conditions (NPUCs) are largely age-related degenerations that affect the majority of adults. Most patients with NPUCs do not seek medical care and adjust on their own. Among those who do seek care, approximately 20% report risky substance use, defined as a consumption pattern that increases the risk of harm to physical or psychosocial health. In the context of NPUC, risky substance use is associated with more intense pain, emotional distress, disability, and opioid or other substance misuse (ie, cross-tolerance). Consequently, risky substance use is a significant modifiable risk factor for the progression and maintenance of chronic pain-related disability and comorbid psychopathology among patients with NPUCs.

OBJECTIVE

This study aims to develop, adapt, and test the feasibility of the Web-Based Toolkit for Resilient Life Beyond Pain and Substance Use (Web-TIRELESS), a novel, asynchronous, and web-based mind-body intervention aimed at modifying maladaptive pain-coping behaviors in patients with NPUC and comorbid risky substance use. This study illustrates the proposed study design, methodology, and intervention content.

METHODS

In aim 1, we will conduct live video qualitative interviews (n=20) with care-seeking adult patients with NPUC and comorbid risky substance use to inform the development and refinement of Web-TIRELESS and study procedures. In aim 2, we propose an open pilot study (n=12) of Web-TIRELESS with exit interviews and pre- and postintervention assessments to evaluate the feasibility, credibility, and acceptability of Web-TIRELESS and refine study procedures. Aim 3 consists of a pilot feasibility randomized controlled trial of Web-TIRELESS versus minimally enhanced usual care (n=50), both of which follow a web-based modality, to demonstrate the feasibility of recruitment procedures and data collection, as well as the feasibility, credibility, and acceptability of Web-TIRELESS and the control condition (adherence, retention, fidelity, and satisfaction), following prespecified benchmarks.

RESULTS

Patient interviews (aim 1) concluded in May 2024 and qualitative analysis is expected to be completed in September 2024. Completion of aim 2 (data collection and analysis) is expected by June 2025. The completion of aim 3 and other study-related operations is anticipated by June 2027.

CONCLUSIONS

We will develop and test Web-TIRELESS, the first asynchronous mind-body intervention specifically adapted to enhance resilience in response to chronic pain among individuals with NPUCs and comorbid risky substance use. Results from this 3-aim study (feasibility, acceptability, and satisfaction of Web-TIRELESS) will be leveraged to inform a future efficacy randomized controlled trial of Web-TIRELESS versus the minimally enhanced usual care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06366633; https://clinicaltrials.gov/study/NCT06366633.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64547.

Health Care Utilization After Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System From 2001 to 2017

OBJECTIVE

To characterize and quantify health care utilization of Military Health System beneficiaries with major limb loss.

DESIGN

Retrospective cohort study.

SETTING

Military treatment facilities and civilian health care facilities that accept TRICARE insurance across the United States.

PARTICIPANTS

A total 5950 adult Military Health System beneficiaries with major limb amputation(s) acquired between January 1st, 2001, and September 30th, 2017 (N=5950).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

This study was an exploratory analysis designed to identify common care specialties, services, and devices utilized by Military Health System beneficiaries with major limb loss.

RESULTS

Most beneficiaries were retirees/dependents (63.3%), men (73.1%), and had a single amputation (88.7%), with a mean age of 42 years. Differences between beneficiary categories were found. Active-duty service members used a larger proportion of inpatient, emergency, primary care, physical and occupational therapy, prosthetics and orthotics, physical medicine and rehabilitation, and psychiatry services than retirees/dependents. Most common procedures included "revision of amputation stump" (57.2%) for the active-duty population and "other amputation below knee" (24.3%) for the retirees/dependents.

CONCLUSIONS

These findings highlight the rehabilitation trajectories of beneficiaries receiving treatment for major limb loss in military and civilian care settings. The results could inform staffing decisions and training programs for military treatment facilities, American trauma centers, rehabilitation hospitals, and outpatient health care providers treating individuals with amputation.

The hidden impact of orthopedic surgeries: Examining the psychological consequences

Orthopedic surgery is commonly considered "quality of life care," as most orthopedic procedures have been shown to provide excellent pain relief and successful surgical outcomes for patients. Although orthopedic surgeries continue to improve patients' functional outcomes through modern surgical techniques and preoperative psychological screening, variation in patient function persists in current studies. Sub-optimal function in patients has been shown to be associated with emotional health burdens, such as anxiety and depression. Previous research has found that preoperative psychological conditions could negatively affect patients' functional outcomes. However, these studies were limited in that they did not examine novel psychological repercussions in emotionally healthy patients following surgery. To address this gap in knowledge, a narrative review was conducted to differentiate specific orthopedic surgeries that have psychological consequences on patients and to determine the current psychological support available for these patients. Data was collected from the Medical Humanities sector of the Texas Medical Center Library and the National Library of Medicine. Studies were included that examined novel psychological effects on patients after undergoing orthopedic surgery. A total of 38 articles were identified, and the majority focused on orthopedic trauma surgery while the rest examined total joint arthroplasty and orthopedic sports procedures. A key finding was that orthopedic trauma surgeries, alone and compared to total joint arthroplasty, result in a greater risk of negative psychological effects, while there was limited data on the psychological effects of orthopedic sports procedures. This narrative review suggests a need to integrate psychosocial support for patients with traumatic orthopedic intervention, regardless of the patient's preoperative psychological state. Furthermore, more research examining the mental well-being of patients following elective orthopedic surgeries is necessary to determine if these operations would benefit from postoperative psychological support as well.

Fair Healthcare Practices in Orthopedics Assessed with a New Framework

Background and Objectives: Healthcare systems are supported by the European ideology to develop their egalitarian concerns and to encourage the correct and fair behavior of medical staff. By integrating fair healthcare practices into sustainability, this requirement is addressed. In this research, our objective is to develop and validate, in the current activity of healthcare facilities, a new instrument for evaluating fair healthcare practices as a component of social responsibility integrated into sustainability. Materials and Methods: The research methods consist of deciding the domains of a new framework that integrates fair healthcare practices; the collection of the most recent fair healthcare practices reported by healthcare facilities around the world; elaboration of the contents and evaluation grids of the indicators; the integration of indicators related to fair healthcare practices in the matrix of the new framework for sustainable development; validation of the theoretical model at an orthopedic hospital. Results: The theoretical model of the new framework is composed of five domains: organizational management, provision of sustainable medical care services, economic, environmental, and social. The last domain is developed on the structure of the seven subdomains of the social responsibility standard ISO 26000. The seven indicators that describe fair healthcare practices are attitudes of the profession towards accreditation, effective intervention application, promoting a culture of patient safety, characteristics that affect the effectiveness of transfers, effective healthcare practices, feedback to medical staff, safety checklists. The new reference framework was implemented and validated in practice at an emergency hospital with an orthopedic profile. Conclusions: The practical implementation highlighted the usefulness of the new reference framework, its compatibility, and the possibility of integration with the reference frameworks for the evaluation of European hospitals, with the national legislation for the accreditation of hospitals and outpatient units, as well as with the ISO 9001 standard regarding the implementation of quality management systems. Its added value consists in promoting sustainable development by orienting staff, patients, and interested parties towards sustainability.