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Naylor JM, Bhandari P, Descallar J, Yang OO, Rider M, Mayland EC, Tang C, Brady B, Lim D, Santalucia Y, Gabbe BJ, Hassett G, Baker E. Comparison of short-term outcomes between people with and without a pre-morbid mental health diagnosis following surgery for traumatic hand injury: a prospective longitudinal study of a multicultural cohort. BMC Musculoskelet Disord 2023; 24:805. [PMID: 37821871 PMCID: PMC10568865 DOI: 10.1186/s12891-023-06931-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Following traumatic hand injury, few studies have compared outcomes between people with and without a pre-morbid mental health diagnosis. This study aimed to compare sub-acute outcomes in a multicultural patient cohort with surgically managed traumatic hand injury with and without a pre-morbid mental health diagnosis. METHODS A prospective, observational cohort study of people with traumatic hand injury presenting pre- surgically to a high-volume hand injury centre in a region of cultural and language diversity was conducted. Participants were assessed face-to-face (baseline) then via telephone (3-months post-surgery) and categorized according to a pre-morbid medically diagnosed mental health diagnosis. Baseline and follow-up assessments included global mental health, and the EuroQol (EQ) 'Health Today' analogue scale (0-100) and health domains. Return-to-work status, complications/symptomatic complaints, and hand function (QuickDASH) were also collected at follow-up. Adjusted analyses-accounting for covariates including cultural identity-were conducted to determine whether 3-month outcomes were associated with a pre-morbid mental health diagnosis. RESULTS From 405 eligible patients, 386 were enrolled (76% male, mean age 38.9 (standard deviation 15.6)); 57% self-identified as Australian and 22% had a pre-morbid mental health diagnosis. Common injuries regardless of pre-morbid mental health diagnosis were skin (40%), tendon (17%) and bone (17%) injuries. None were complex mutilating injuries. Seventy-eight per cent of the cohort was followed-up. In adjusted analyses, a pre-morbid mental health diagnosis was associated with lower odds for reporting 'good or better' global mental health (Odds Ratio (OR) 0.23 (95% Confidence Interval (CI) 0.18, 0.47), p < 0.001), 'no' anxiety or depression (OR 0.21 (0.11, 0.40), p < 0.001) and no pain (OR 0.56 (0.31, 0.98), p = 0.04)(EQ domains), and worse EQ 'Health Today' (10 points on average (95%CI -14.9, -5.1, p < 0.001). QuickDASH scores, rates of complications/symptomatic complaints and return-to-work profiles were similar. CONCLUSIONS Despite reporting worse mental and health-related quality-of-life outcomes post-surgery, people with a pre-morbid mental health diagnosis regardless of cultural identity experienced similar clinical and return-to-work outcomes. Future research assessing the value of screening for pre-morbid mental health conditions on post-surgical outcomes is required and should include people with more complex hand injuries.
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Affiliation(s)
- Justine M Naylor
- Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia.
| | - Pratibha Bhandari
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Joseph Descallar
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
| | - Owen Ou Yang
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Mark Rider
- South Western Sydney Hand Centre at Fairfield Hospital, Cnr Polding St. & Prairievale Road, Prairiewood, NSW, 2176, Australia
| | - Elizabeth C Mayland
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Clarice Tang
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Bernadette Brady
- Department of Pain Medicine, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Yvonne Santalucia
- Multicultural Health Service, South West Sydney Local Health District, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Geraldine Hassett
- Rheumatology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- South Western Sydney Clinical School, Faculty of Medicine, UNSW, Liverpool, BC 1871, NSW, Australia
| | - Elise Baker
- Ingham Institute of Applied Medical Research, 1 Campbell St, Liverpool, NSW, 2170, Australia
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- South Western Sydney Local Health District, Liverpool, Locked Bag 7279, Liverpool BC, 1871, Australia
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Collar J, Smetona J, Zhang J, Deng Y, Clune J. The Aesthetics of Digit Amputation. Hand (N Y) 2023; 18:829-837. [PMID: 35174717 PMCID: PMC10336824 DOI: 10.1177/15589447211065073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The goal of surgery, when treating a patient with a traumatized hand, is to restore function. The importance of the aesthetics on a patient's psychological well-being should also be considered. The biomechanical ideals for creating a useful hand after digit amputation have been defined; however, ideal aesthetic levels for finger amputation have not been elucidated. The purpose of this study was to determine the general population's visual preferences for different levels of digit amputation in the hand. Methods: In all, 310 participants were surveyed to identify preferences of different levels of single digit amputations in dorsal and volar views. A normal hand was digitally manipulated to simulate various levels of digit amputation. The aesthetics of amputation at the distal interphalangeal (DIP) joint, proximal interphalangeal (PIP) joint, metacarpophalangeal (MCP) joint, and ray amputation were compared to one another via rank order. Average rank for each level of amputation for a digit was determined. Results: Amputation at the DIP was favored over all other levels; however, ray amputation was the second most aesthetic, particularly in the middle and ring fingers even when compared to amputation at the PIP level. Conclusion: When presented a choice at which level to perform a completion amputation or a primary amputation of a digit, and functionality at multiple levels of amputation is equivocal, aesthetic outcomes should be considered. Amputation at the DIP joint is preferable, but ray amputation is aesthetically more pleasing than amputation at the PIP or MCP joints in the index, middle, ring, and small fingers.
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Affiliation(s)
- John Collar
- Yale University School of Medicine, Section of Plastic Surgery, New Haven, CT, USA
| | - John Smetona
- Yale University School of Medicine, Section of Plastic Surgery, New Haven, CT, USA
| | - Jingwen Zhang
- Yale University School of Public Health Center for Analytical Science, New Haven, CT, USA
| | - Yanhong Deng
- Yale University School of Public Health Center for Analytical Science, New Haven, CT, USA
| | - James Clune
- Yale University School of Medicine, Section of Plastic Surgery, New Haven, CT, USA
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Maddison K, Perry L, Debono D. Psychological sequelae of hand injuries: an integrative review. J Hand Surg Eur Vol 2023; 48:33-40. [PMID: 36039570 DOI: 10.1177/17531934221117429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This integrative review investigated reports of psychological impact and sequelae of traumatic hand injuries. A systematic search using Medline, PsychINFO, PubMed, EMBASE, CINAHL and hand-searching methods was conducted from 2008 to 2020. Nine included articles with a total of 503 participants were reported in prospective cross-sectional or longitudinal cohort studies. Depression and anxiety were common, affecting between 7% and 71% and between 23% and 71% of patients, respectively. Post-traumatic stress disorder affected between 3% and 95% of patients. Factors reported predicting psychological sequelae of hand injuries included injury severity, pain, limb dysfunction, negative perceptions of injured limbs, suboptimal coping mechanisms and limited social support. Symptoms persisted for protracted periods of follow-up but broadly attenuated after 3 months. We conclude that the high prevalence and enduring nature of psychological symptoms demonstrate an urgent need for further research to optimize treatment.Level of evidence: III.
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Affiliation(s)
- Kay Maddison
- University of Technology Sydney, Sydney, NSW, Australia.,Hand Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, NSW, Australia
| | - Lin Perry
- University of Technology Sydney, Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
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The Psychological and Somatic Consequences of Digital Amputation. Plast Reconstr Surg Glob Open 2022; 10:e4387. [PMID: 35747254 PMCID: PMC9208886 DOI: 10.1097/gox.0000000000004387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Abstract
Major limb amputation is a devastating potential outcome of trauma, tumor, or disease. Much has been written about the physical, functional, economic, and psychological consequences of major limb loss. In contradistinction, considerably less has been written concerning the consequences of "minor" limb loss, specifically single partial digit amputations. Are minor limb (partial single digit) amputations associated with symptoms of psychological disorder similar to those reported for major limb amputations? Methods We conducted a clinical research study through interview and examination of 25 adult patients (average age: 45 years) who had suffered a single partial digit amputation to determine if symptoms of depression, anxiety, anger, or posttraumatic stress disorder newly occurred, and if such symptoms correlated with the surgical outcome. Questionnaires for Quick-DASH, Michigan Hand Score, and Diagnostic and Statistical Manual of Mental Disorders-5 Psychological Profile testing were completed. Results All but one of the patients suffered from psychological symptoms for a minimum of 3 months. Symptom resolution time averaged 6 months for seven of the 25 patients. For 18 of the 25 patients, both psychological disturbance and neuroma pain were ongoing. The Psychological Profile scores suggesting pathology were inversely related to the scores on the Quick-Dash and Michigan Hand (somatic) questionnaires indicating wellness (P < 0.03). Conclusions (1) Even minor partial amputations of single digits can trigger significant psychological disturbance; the study hypothesis is validated. (2) Psychological and somatic outcomes are directly correlative. (3) Mitigating neuroma pain and verbally offering psychological support services early in the postamputation period should improve the clinical outcome of digital amputations.
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Dhillon NK, Kolus RC, Patel KA, Conde G, Perez J, Holtz H, Ley EJ. A designated trauma social worker improves coordination of patient care by coordinating ancillary consults. SOCIAL WORK IN HEALTH CARE 2022; 61:158-168. [PMID: 35579262 DOI: 10.1080/00981389.2022.2076763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/04/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Trauma patients face unique challenges that require coordination by social workers knowledgeable in the intricacies of trauma patient psychosocial support which is often achieved by obtaining ancillary consultations. The impact of employing a designated trauma social worker (DTSW) in the utilization of these consults has not been described. A retrospective review was conducted of trauma patients admitted to an academic, urban Level 1 trauma center. The pre-intervention cohort (n = 272) corresponded to patients admitted before the presence of a DTSW (01/2013 to 06/2013), while the post-intervention cohort (n = 282) corresponded to patients admitted afterward (09/2015 to 01/2016). Data collection included demographics, injury profile, and types of interdisciplinary or therapy consultations. Post-intervention patients were found to be older and admitted with more injuries. Supportive care, physical therapy and occupational therapy consultations were more likely to be obtained in the post-intervention cohort. Hospital length of stay remained unchanged. This study suggests that the implementation of a DTSW significantly facilitates the utilization of interdisciplinary consultations. Length of stay remains unchanged, suggesting that a DTSW helps to coordinate care in a timely manner without increasing the hospital stay. DTSW implementation may be considered in trauma centers where one does not currently exist.
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Affiliation(s)
- Navpreet K Dhillon
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Riley C Kolus
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kavita A Patel
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Geena Conde
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jazmin Perez
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Heidi Holtz
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eric J Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Liu S, Xu R, Liu L. Influencing Factors of Acute Stress Disorder Among Frontline Nurses in Wuhan, China. J Psychosoc Nurs Ment Health Serv 2021; 59:38-47. [PMID: 34110951 DOI: 10.3928/02793695-20210324-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The current study aimed to investigate the influencing factors of acute stress disorder (ASD) in frontline nurses delivering care in a hospital for COVID-19 in Wuhan, China. In this cross-sectional study, 298 frontline nurses were surveyed during the first month of direct care delivery for patients with COVID-19 via the Stanford Acute Stress Reaction Questionnaire, Simplified Coping Style Questionnaire, and Multidimensional Scale of Perceived Social Support. Through logistic regression analysis, we identified the influencing factors of ASD. Our results showed that 13.8% of participants had ASD; frontline nurses were affected by ASD symptoms in different degrees; higher perceived social support from friends and colleagues were the major protective factors of ASD; and a negative coping style was a risk factor for ASD. Psychological crisis management interventions aimed at frontline nurses may be essential to prevent ASD during public health crisis events. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 38-47.].
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The Psychological Impact of Adult Traumatic Brachial Plexus Injury. J Hand Surg Am 2018; 43:950.e1-950.e6. [PMID: 29678427 DOI: 10.1016/j.jhsa.2018.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 12/29/2017] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE There is a high incidence of posttraumatic stress disorder (PTSD), depression, suicide risk, and psychological distress after orthopedic trauma and hand and upper-extremity injury. Although patients with traumatic adult brachial plexus injury are particularly vulnerable to psychologic distress, minimal clinical data exist about this cohort of patients. In this study, we sought to discover the prevalence of depression, PTSD, suicidal ideation, and substance abuse. METHODS Between February, 2013 and July, 2014, during scheduled preoperative and/or postoperative appointments, the social worker at a metropolitan brachial plexus center conducted psychosocial assessments and questionnaire assessments of 21 patients evaluating for PTSD, depression, and substance use using 3 validated scales: PTSD Checklist-Specific, Patient Health Questionnaire-8, and National Institute on Drug Abuse Quick Screen. RESULTS Brachial plexus injury strongly affected self-reported psychological well-being; 7 of 21 (33.3%) divulged suicidal ideation. Diagnosticand Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnosis was supported by PTSD Checklist-Specific and Patient Health Questionnaire-8 results: 4 of 21 (19.0%) met criteria for PTSD and 4 of 21 (19.0%) exhibited clinical depression. Patients reported no changes in social alcohol and tobacco use or substance abuse. CONCLUSIONS Brachial plexus injury significantly influences psychological well-being and daily functioning. As a result, patients experience a high prevalence of PTSD, depression, and suicidal ideation. Patients with brachial plexus injury have a high prevalence of psychological concerns and challenges that require continued attention throughout treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Ladds E, Redgrave N, Hotton M, Lamyman M. Systematic review: Predicting adverse psychological outcomes after hand trauma. J Hand Ther 2018; 30:407-419. [PMID: 28237074 DOI: 10.1016/j.jht.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION AND PURPOSE OF THE STUDY After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited. METHODS A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed. RESULTS Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes. DISCUSSION AND CONCLUSION Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Emma Ladds
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
| | - Nathalie Redgrave
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Matthew Hotton
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Michael Lamyman
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Chen J, Zhang AX, Chen QZ, Mu S, Tan J. Long-term functional, subjective and psychological results after single digit replantation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:120-126. [PMID: 29454562 PMCID: PMC6136331 DOI: 10.1016/j.aott.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 09/02/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023]
Abstract
Objective The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation. Methods Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20–65 years) were evaluated at the end of a mean follow-up time of 36 months (19–50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed. Results The mean score for the DASH questionnaire was 6.6 (range: 0–39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05). Conclusion Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up. Level of evidence Level IV, therapeutic study.
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Miller C, Peek AL, Power D, Heneghan NR. Psychological consequences of traumatic upper limb peripheral nerve injury: A systematic review. HAND THERAPY 2016. [DOI: 10.1177/1758998316679387] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction Traumatic upper limb peripheral nerve injuries significantly impact individuals’ function and ability to return to work. Patients with peripheral nerve injury experience ongoing psychological impairments for which they are not routinely treated. The aim of this review was to investigate the psychological consequences of traumatic upper limb peripheral nerve injury. Methods A systematic review of MEDLINE, Embase, PsycINFO, CINAHL, AMED, BNI, the Cochrane libraries and grey literature up to October 2015 was undertaken. Two reviewers independently assessed methodological quality in accordance with Cochrane Collaboration recommendations. Eligibility criteria comprised: adults or adolescents with traumatic upper limb peripheral nerve injury using any measurement of psychological well-being. Results Six studies ( n = 245) met the inclusion criteria. Methodological quality varied widely. Evidence of post-traumatic stress disorder at one month, which decreased over time, was reported in three studies. Two studies found a statistically significant correlation between the early presence of post-traumatic stress disorder and reduction in function at 12 or more months. Limited information was available on anxiety, depression and mental quality of life. Combined nerve injuries (in two studies) had significantly higher levels of post-traumatic stress disorder, at one month, compared to those with an isolated nerve injury. Conclusion There is some evidence of early post-traumatic stress disorder following traumatic upper limb peripheral nerve injury, which may have an impact on functional outcome. However, high-quality studies using prospective cohorts are required to further evaluate the psychological aspects associated with this traumatic injury.
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Affiliation(s)
- Caroline Miller
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Dominic Power
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Implementing a tailored approach for the hand-injured patient: a prospective study on the evolution of the posttraumatic psychic distress. J Trauma Nurs 2013; 20:178-83. [PMID: 24305078 DOI: 10.1097/jtn.0000000000000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mutilating hand injuries are frequently associated with the development of psychic impairments such as posttraumatic stress disorder, depression, regression of the personality, and refusal of the disease. The psychic distress acts as a source of disability that outweighs the functional loss, causing impairments that may prevent a full recovery after the accident. The present study highlights the need for nurses to be familiar with the emotional response in the patients, to implement a specialized and comprehensive approach and detect stress points that may require early intervention.
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Mathieu L, Guillibert E, Mamane W, Masmejean EH. The psychotic mummified hand: an unusual hand injury complication. ACTA ACUST UNITED AC 2013; 32:413-5. [PMID: 24145122 DOI: 10.1016/j.main.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/07/2013] [Accepted: 09/15/2013] [Indexed: 11/24/2022]
Abstract
The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a "mummified" hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3 years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up.
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Affiliation(s)
- L Mathieu
- Hand Surgery Unit, Orthopaedics and Trauma Department, Paris-Descartes University, Sorbonne Paris-Cité, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - E Guillibert
- Department of psychiatry, Paris-Descartes University, Sorbonne Paris-Cité, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - W Mamane
- Hand Surgery Unit, Orthopaedics and Trauma Department, Paris-Descartes University, Sorbonne Paris-Cité, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - E H Masmejean
- Hand Surgery Unit, Orthopaedics and Trauma Department, Paris-Descartes University, Sorbonne Paris-Cité, Georges-Pompidou European Hospital (HEGP), AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France.
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Consequences and adaptation in daily life - patients' experiences three decades after a nerve injury sustained in adolescence. BMC Musculoskelet Disord 2013; 14:252. [PMID: 23968274 PMCID: PMC3765266 DOI: 10.1186/1471-2474-14-252] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background To explore the patients’ experiences during the three decades following repair of a nerve injury in the forearm and its consequences for daily life. Strategies that were used to facilitate adaptation were also investigated. Methods Fifteen participants with a complete median and/or ulnar nerve injury repaired in the ages from 13–20 years were interviewed using a semi-structured interview guide. The median follow-up time was 31 years (range 23–40). The participants were asked to describe the past and present symptoms of the injured hand, the consequences of the injury for daily life, personal qualities and support from others. In addition, they were asked to describe strategies used to facilitate adaptation. The interviews were subjected to content analysis. Results The nerve injury lead to sensory and motor deficits in the injured hand, as well as sensitivity to cold and secondary back problems. Emotional reactions to trauma and symptoms related to post-traumatic stress disorder were described, as well as how they managed to cope with such reactions. There was a noticeable impact on education, leisure, professional or domestic life for some, while others could continue by changing e.g. their performance pattern. The participants’ life roles and relations were also affected. Both emotion- and problem-based strategies were used to manage challenges in daily life. Conclusions The present qualitative study can help us to provide the patient with honest and realistic information about what to expect after a nerve injury at forearm level, without eliminating hope. Emotional reactions to trauma should be identified and dealt with. In addition, health-care professionals can promote a variety of coping mechanisms to facilitate daily living for the injured patients.
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Panagopoulou P, Antonopoulos CN, Dessypris N, Kanavidis P, Michelakos T, Petridou ET. Epidemiological patterns and preventability of traumatic hand amputations among adults in Greece. Injury 2013; 44:475-80. [PMID: 23122997 DOI: 10.1016/j.injury.2012.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 09/25/2012] [Accepted: 10/10/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hand/finger amputations though rare account for significant disability and health-related costs; yet, information on underlying causes, springing mostly from physicians' reports, is rather anecdotal. We sought to draw attention to the high preventable fraction of hand/finger amputations among adults in Greece. PATIENTS AND METHODS Data on external cause of injury and short-term outcome, recorded over nine years in the Emergency Department Injury Surveillance System (EDISS) were analysed, whereas sample weights were used for nationwide extrapolations. RESULTS Hand/finger injuries accounted for 20.4% (N = 57,986) among 284,705 injuries recorded in patients >14-year-old (3% annual probability); 728 (1.3%) resulted in amputations; the estimated incidence rate (IR) was 39.3/100,000 person-years, reaching a high 92.6/100,000 among males aged 45-64 years. As expected, the vast majority of victims were males (90%), frequently young immigrants; ∼two-thirds sustained occupational injuries during working hours. Objects most frequently involved included: machinery (57% overall/69% occupational), means of transport (10.4%), materials (9.5%), parts of buildings/furniture (5%). Wood-working was the most common risk factor (20% overall/28% occupational) whereas 6% of victims accepted own inattention. 30% of amputations were hospitalised whereas 10% transferred to specialised units. DISCUSSION Specialised registries reveal the magnitude and specific causes of disabling hand injuries and point to tailored national injury prevention programs; specifically in Greece, as they occur in more controlled occupational environments among middle-aged males, woodworkers, and are caused mainly by machinery. CONCLUSIONS Increased management of safety in the workplace could play a role in reduction in hand amputations.
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Affiliation(s)
- Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology, and Medical Statistics, Athens University Medical School, Athens, Greece
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Gustafsson M, Windahl J, Blomberg K. Ten years follow-up of trauma-related psychological distress in a cohort of patients with acute traumatic hand injury. Int J Orthop Trauma Nurs 2012. [DOI: 10.1016/j.ijotn.2012.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cohen M, Meir T, Klein E, Volpin G, Assaf M, Pollack S. Cytokine levels as potential biomarkers for predicting the development of posttraumatic stress symptoms in casualties of accidents. Int J Psychiatry Med 2012; 42:117-31. [PMID: 22409092 DOI: 10.2190/pm.42.2.b] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Traumatic injuries are usually associated with increased secretion of pro-inflammatory cytokines, and are sometimes followed by the development of acute stress symptoms (ASS) and posttraumatic stress symptoms (PTSS). AIMS To measure serum pro- and anti-inflammatory cytokines in accident casualties and to associate it with ASS at hospitalization, and with PTSS 1 month later. METHODS Participants were 48 patients, aged 20-60, hospitalized following various orthopedic injuries including bone fractures, and 13 healthy volunteers matched for gender. At hospitalization (Time 1), 30 ml heparinized venous blood were drawn and cytokines levels in serum were assessed; participants filled out the Acute Stress Disorder Inventory (ASDI), COPE, and injury-related questionnaires. One month later (Time 2), 26 participants filled out the Posttraumatic Disorder Symptom Scale (PDS). RESULTS High serum levels of IL-6, IL-8, and TGF-beta and low levels of serum IL-4 and IL-10 were found in injured patients as compared with controls, When controlling for age and severity of injury in the regression analysis, higher levels of IL-6 and IL-8 and lower TGF-beta were predicted by higher ASS and higher use of and emotion-focused coping. Higher PTSS scores at Time 2 were predicted by higher levels of IL-8, lower levels of TGF-beta, and higher ASS measured at Time 1. CONCLUSIONS High levels of the pro-inflammatory cytokine IL-6 and IL-8 and lower levels of the regulatory cytokine TGF-beta should be further assessed as a possible risk factor or a bio-marker of PTSS in accident casualties.
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Gong HS, Lee JO, Huh JK, Oh JH, Kim SH, Baek GH. Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation. Injury 2011; 42:1266-70. [PMID: 21310409 DOI: 10.1016/j.injury.2011.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/27/2010] [Accepted: 01/04/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patients with orthopaedic trauma experience substantial psychological and physical morbidities. The purpose of this study was to assess depressive symptoms in patients with a distal radius fracture, and to determine whether early use of the wrist after volar plating reduces depressive symptoms as compared with cast immobilisation during the early recovery period. MATERIALS AND METHODS Twenty-six patients with a distal radius fracture, who underwent volar plating and were allowed immediate use of the wrist, and 24 patients treated by cast immobilisation for 6 weeks were prospectively compared with respect to depressive symptoms at week 0, and at 2, 6, 12 and 24 weeks after injury, using the Center for Epidemiologic Studies Depression Scale (CES-D). Physical morbidity was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a pain Numerical Rating Scale (NRS). Multivariate analysis was performed to identify factors that independently predicted CES-D scores at each time point. RESULTS No differences in the CES-D scores were found between the volar plating and the cast immobilisation groups, although volar plating group had marginally better CES-D scores at 24 weeks. Multivariate analysis indicated that CES-D scores at each time were independently associated with pain NRS scores at 0 and 24 weeks, and DASH scores at 6 weeks. CONCLUSION Early use of the wrist after volar plating was not found to reduce depressive symptoms as compared with cast immobilisation in the early treatment period following a distal radius fracture. Pain was found to be an important predictor of depression, suggesting that caution is needed to address pain during the early rehabilitation period.
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Affiliation(s)
- Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Goomi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
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