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Parker RS, Nazzal MK, Morris AJ, Fehrenbacher JC, White FA, Kacena MA, Natoli RM. Role of the Neurologic System in Fracture Healing: An Extensive Review. Curr Osteoporos Rep 2024; 22:205-216. [PMID: 38236509 PMCID: PMC10912173 DOI: 10.1007/s11914-023-00844-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Despite advances in orthopedics, there remains a need for therapeutics to hasten fracture healing. However, little focus is given to the role the nervous system plays in regulating fracture healing. This paucity of information has led to an incomplete understanding of fracture healing and has limited the development of fracture therapies that integrate the importance of the nervous system. This review seeks to illuminate the integral roles that the nervous system plays in fracture healing. RECENT FINDINGS Preclinical studies explored several methodologies for ablating peripheral nerves to demonstrate ablation-induced deficits in fracture healing. Conversely, activation of peripheral nerves via the use of dorsal root ganglion electrical stimulation enhanced fracture healing via calcitonin gene related peptide (CGRP). Investigations into TLR-4, TrkB agonists, and nerve growth factor (NGF) expression provide valuable insights into molecular pathways influencing bone mesenchymal stem cells and fracture repair. Finally, there is continued research into the connections between pain and fracture healing with findings suggesting that anti-NGF may be able to block pain without affecting healing. This review underscores the critical roles of the central nervous system (CNS), peripheral nervous system (PNS), and autonomic nervous system (ANS) in fracture healing, emphasizing their influence on bone cells, neuropeptide release, and endochondral ossification. The use of TBI models contributes to understanding neural regulation, though the complex influence of TBI on fracture healing requires further exploration. The review concludes by addressing the neural connection to fracture pain. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Reginald S Parker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Murad K Nazzal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashlyn J Morris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jill C Fehrenbacher
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fletcher A White
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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Nazzal MK, Morris AJ, Parker RS, White FA, Natoli RM, Kacena MA, Fehrenbacher JC. Do Not Lose Your Nerve, Be Callus: Insights Into Neural Regulation of Fracture Healing. Curr Osteoporos Rep 2024; 22:182-192. [PMID: 38294715 PMCID: PMC10912323 DOI: 10.1007/s11914-023-00850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Fractures are a prominent form of traumatic injury and shall continue to be for the foreseeable future. While the inflammatory response and the cells of the bone marrow microenvironment play significant roles in fracture healing, the nervous system is also an important player in regulating bone healing. RECENT FINDINGS Considerable evidence demonstrates a role for nervous system regulation of fracture healing in a setting of traumatic injury to the brain. Although many of the impacts of the nervous system on fracture healing are positive, pain mediated by the nervous system can have detrimental effects on mobilization and quality of life. Understanding the role the nervous system plays in fracture healing is vital to understanding fracture healing as a whole and improving quality of life post-injury. This review article is part of a series of multiple manuscripts designed to determine the utility of using artificial intelligence for writing scientific reviews.
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Affiliation(s)
- Murad K Nazzal
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ashlyn J Morris
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Reginald S Parker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fletcher A White
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, USA
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa A Kacena
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Jill C Fehrenbacher
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
- Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Farzad M, MacDermid J, Hemmati M, Farhoud AR. Occupational Performance 1 Year After a Distal Radius Fracture From the Perspective of the International Classification of Functioning, Disability and Health. Am J Occup Ther 2023; 77:7705205040. [PMID: 37793017 DOI: 10.5014/ajot.2023.050180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
IMPORTANCE Distal radius fractures (DRFs) frequently compromise independent functioning. OBJECTIVE To analyze occupational performance post-DRF using the Canadian Occupational Performance Measure (COPM) and related interviews, guided by the International Classification of Functioning, Disability and Health (ICF). COPM score was compared with standard metrics: Patient-Reported Wrist Evaluation (PRWE) and Participation Behavior Questionnaire (PBQ). METHOD Through a semistructured COPM interview, participants highlighted self-care, productivity, and leisure. They completed the PRWE and PBQ, linking results to ICF sets. DESIGN Prospective cohort. SETTING Outpatient hand surgery clinic at a trauma center. PARTICIPANTS Patients (N = 120), 1 yr post-DRF. OUTCOMES AND MEASURES Incorporated COPM, PRWE, and PBQ, linked to ICF. RESULTS Analysis identified 73 codes, aligning with 30 ICF Hand Conditions codes. Main concerns related to self-care (15.21%), leisure (12.16%), and productivity (16.22%). Major challenges pertained to domestic (67.00%) and civic life (64.53%) within ICF. Occupational performance was positively correlated with participation (r = .62) and inversely with disability (r = -.62). CONCLUSIONS AND RELEVANCE DRFs result in varied occupational challenges that are not always reflected in standard measures. The COPM offers a comprehensive insight into post-DRF patient challenges, emphasizing the value of diverse clinical assessment approaches. What This Article Adds: This study highlights the importance of a holistic approach in occupational therapy for DRF patients, revealing that standard measurements might overlook key challenges that they face. By adopting broader evaluative methods, occupational therapists can better address patient-specific needs and enhance their rehabilitation outcomes.
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Affiliation(s)
- Maryam Farzad
- Maryam Farzad, PhD, MSc, BSc, is Postdoctoral Associate, School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada, and Assistant Professor, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran;
| | - Joy MacDermid
- Joy MacDermid, PhD, MSc, BSc, is Professor, Department of Physical Therapy and Surgery, Western University, London, Ontario, Canada; Codirector, Clinical Research Laboratory, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; and Professor, Department of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Motahar Hemmati
- Motahar Hemmati, BSc OT, is Master's Student, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Amir Reza Farhoud
- Amir Reza Farhoud, MD, is Assistant Professor, Department of Orthopedic Surgery, Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Tehran, Iran
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Şentürk İA, Aşkın Turan S, Eyigürbüz T, Şentürk E, Kale İçen N. Pain-Related Cognitive Processes, Pain Interference, and Alexithymia in Patients With Primary Headaches. Cureus 2023; 15:e39688. [PMID: 37398774 PMCID: PMC10309013 DOI: 10.7759/cureus.39688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives This study aims to investigate the effects of pain-related cognitive processes (PRCPs) and emotional state on pain-related disability (PRD) and pain interference (difficulty in performing daily routines, difficulty in engaging in social activities [the enjoyment of life], and the impact on work and/or school performance) in patients with primary headaches (PHs). Methodology PRCPs were evaluated with the Pain Anxiety Symptom Scale-20 (PASS-20), Pain Catastrophizing Scale (PCS), and Pain Belief Questionnaire (PBQ). Anxiety, depression, and alexithymia were investigated to assess the emotional state. PRD was assessed by Headache Impact Test-6 (HIT-6). Health-related quality of life (HRQoL) was evaluated under three headings: daily activities (with Short Form-36 [SF-36] Question [Q] 22), social activities (with Graded Chronic Pain Scale-Revised [GCPS-R] Q 4), as well as the working ability (with GCPS-R Q 5). Two separate models were constructed to identify the factors influencing PRD and HRQoL in PHP: M1 to reveal the factors affecting PRD and M2 to determine the independent factors affecting pain interference. In both models, correlation analysis was applied first and the significant data were then evaluated with regression analysis. Results A total of 364 participants (74 healthy controls [HCs] and 290 PHPs) completed the study. In M1, the following domains were significantly associated with PRD: cognitive anxiety (β = 0.098; 95% confidence interval [CI] = 0.001-0.405; P = 0.049); helplessness (β = 0.107; 95% CI = 0.018-0.356; P = 0.031); alexithymia (β = 0.077; 95% CI = 0.005-0.116; P = 0.033); depression (β = 0.083; 95% CI = 0.014-0.011; P = 0.025). In M2, factors associated with impairment in daily activities for PHP were as follows: duration of pain, pain intensity, alexithymia, escape-avoidance response, psychological anxiety, anxiety, and poor sleep quality (R = 0.770; R2 = 0.588). The independent factors affecting social activities for PHP were pain intensity and pain-related anxiety (R = 0.90; R2 = 0.81). Independent risk factors that affected the ability to work for PHP were pain intensity, cognitive anxiety, escape-avoidance response, and pain anxiety (R = 0.90; R2 = 0.81). Conclusions This study highlights the importance of cognitive and emotional processes that help increase our understanding of the patient with PHs. This understanding may help to reduce disability and improve the quality of life in this population by helping to guide multidisciplinary treatment goals.
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Affiliation(s)
| | - Suna Aşkın Turan
- Pain Management, Mersin City Education and Research Hospital, Mersin, TUR
| | - Tuğba Eyigürbüz
- Neurology, Bağcılar Education and Research Hospital, İstanbul, TUR
| | - Erman Şentürk
- Psychiatry, NP Feneryolu Medical Center, Üsküdar University, İstanbul, TUR
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Luk MLM, Chan ACM, Cho JSY, Ng DMT, Lam ICY, Yau ELK, Miller T, Pang MYC. Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1535-1543. [PMID: 36973426 DOI: 10.1007/s00264-023-05785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization. METHODS This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks. RESULTS One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001). CONCLUSIONS Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.
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Jakobsson H, Lundqvist E, Wretenberg P, Sagerfors M. Pulp-to-palm distance after plate fixation of a distal radius fracture corresponds to functional outcome. Arch Physiother 2023; 13:6. [PMID: 36941730 PMCID: PMC10029229 DOI: 10.1186/s40945-023-00159-4] [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: 05/30/2022] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Several factors can influence the outcome after a distal radius fracture (DRF). The aim of this study was to assess whether postoperative pulp-to-palm (PTP) distance correlated with functional outcomes after plate fixation of DRF. MATERIALS & METHODS This is a secondary analysis of a randomized controlled trial aimed to investigate the effects of plate fixation in patients with type-C fractures. Subjects (N = 135) were divided into 2 groups based on PTP distance (equal to or higher than 0 cm) at 4 weeks postoperatively. Outcome measures were collected prospectively at 3, 6 and 12 months and included Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) scores, wrist range of motion (ROM), Visual Analog Scale (VAS) pain scores, and hand grip strength. RESULTS Overall, at 3 and 6 months patients with PTP > 0 cm had significantly worse outcomes (PRWE, QuickDASH, wrist ROM) than those with PTP =0 cm. At 12 months, QuickDASH and wrist ROM were still significantly worse. In the volar-plating subgroup, patients with PTP > 0 cm had significantly worse wrist ROM and grip strength at 3 months, but no significant differences were found in subsequent follow-ups. In the combined-plating group, patients with PTP > 0 cm had significantly worse QuickDASH, wrist ROM and grip strength at 3 months. At 6 and 12 months, wrist ROM was still significantly worse. CONCLUSIONS Measurement of PTP distance appears to be useful to identify patients likely to have worse outcome after plating of a DRF. This could be a tool to improve the allocation of hand rehabilitation resources.
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Affiliation(s)
- Hugo Jakobsson
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Eva Lundqvist
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
| | - Per Wretenberg
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
| | - Marcus Sagerfors
- Department of Hand and Orthopedic Surgery, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
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Blomstrand J, Kjellby Wendt G, Karlsson J, Wangdell J, Fagevik Olsén M. Pain, hand function, activity performance and apprehensiveness, in patients with surgically treated distal radius fractures. J Plast Surg Hand Surg 2023; 57:247-252. [PMID: 35510735 DOI: 10.1080/2000656x.2022.2060992] [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: 10/18/2022]
Abstract
Distal radius fracture (DRF) is a common injury, affecting both function and activity performance. Postoperative rehabilitation is an essential part of the treatment of a surgically treated DRF. The study aims were to assess pain, hand function, activity performance and apprehensiveness and their association, during the first three months after a surgically treated DRF. Eighty-eight patients with a DRF were assessed for pain, hand function, activity performance and apprehensiveness three days and two, six and 12 weeks after surgery. The results indicated that pain, range of motion (ROM), grip strength, apprehensiveness, and activity performance (PRWE) improved significantly between follow-ups (p < .001-.01). Apprehensiveness correlated moderately with activity performance on all visits (0.40-0.47, p < .01), which implies a correlation between the variables, but the regression model showed that the differences in the PRWE at twelve weeks cannot be explained by the differences in apprehensiveness or range of motion at cast removal. At 12 weeks, the study participants had regained almost 70% of their grip strength and 74-96% of the ROM of the uninjured hand.The study shows that, during the study period, the participants improved in both pain, hand function and activity performance, and indicates that a simple question on apprehensiveness in terms of using the injured hand in daily life could be an important factor in distal radius fracture rehabilitation.
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Affiliation(s)
- J Blomstrand
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Kjellby Wendt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Health and Rehabilitation - Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Wangdell
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre of Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Fagevik Olsén
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Health and Rehabilitation - Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Şentürk İA, Şentürk E, Üstün I, Gökçedağ A, Yıldırım NP, İçen NK. High-impact chronic pain: evaluation of risk factors and predictors. Korean J Pain 2023; 36:84-97. [PMID: 36581599 PMCID: PMC9812691 DOI: 10.3344/kjp.22357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
Background The concept of high-impact chronic pain (HICP) has been proposed for patients with chronic pain who have significant limitations in work, social life, and personal care. Recognition of HICP and being able to distinguish patients with HICP from other chronic pain patients who do not have life interference allows the necessary measures to be taken in order to restore the physical and emotional functioning of the affected persons. The aim was to reveal the risk factors and predictors associated with HICP. Methods Patients with chronic pain without life interference (grade 1 and 2) and patients with HICP were compared. Significant data were evaluated with regression analysis to reveal the associated risk factors. Receiving operating characteristic (ROC) analysis was used to evaluate predictors and present cutoff scores. Results One thousand and six patients completed the study. From pain related cognitive processes, fear of pain (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.98; P = 0.007) and helplessness (OR, 1.06; 95% CI, 1.01-1.12; P = 0.018) were found to be risk factors associated with HICP. Predictors of HICP were evaluated by ROC analysis. The highest discrimination value was found for pain intensity (cut-off score > 6.5; 83.8% sensitive; 68.7% specific; area under the curve = 0.823; P < 0.001). Conclusions This is the first study in our geography to evaluate HICP with measurement tools that evaluate all dimensions of pain. Moreover, it is the first study in the literature to evaluate predictors and cut-off scores using ROC analysis for HICP.
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Affiliation(s)
- İlteriş Ahmet Şentürk
- Department of Pain Medicine, Bagcilar Education and Research Hospital, Istanbul, Turkiye
| | - Erman Şentürk
- Department of Psychiatry, Üsküdar University NP Feneryolu Medical Center, Istanbul, Turkiye,Correspondence: Erman Şentürk Department of Psychiatry, Üsküdar University NP Feneryolu Medical Center, Ahmet Mithat Efendi Cad. No:17 (Bağdat Cad. Sahil Yolu Kalamış Mevkii) - 34726 Fenerbahçe – Kadıköy, Istanbul, Turkiye, Tel: +902164181500, Fax: +902164181530, E-mail:
| | - Işıl Üstün
- Department of Physical Medicine and Rehabilitation, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkiye
| | - Akın Gökçedağ
- Department of Neurosurgery, Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkiye
| | - Nilgün Pulur Yıldırım
- Department of Neurology, Bagcilar Education and Research Hospital, Istanbul, Turkiye
| | - Nilüfer Kale İçen
- Department of Neurology, Bagcilar Education and Research Hospital, Istanbul, Turkiye
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Kır MÇ, Özen V, Mutlu M, Çabuk H, Kır G. Is Pregabalin Addition to Infraclavicular Block, Effective in Distal Radius Surgery? JOURNAL OF ACADEMIC RESEARCH IN MEDICINE 2022. [DOI: 10.4274/jarem.galenos.2022.50251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Modarresi S, MacDermid JC, Walton DM, King GJW. Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years. J Hand Surg Am 2022:S0363-5023(22)00545-7. [PMID: 36566104 DOI: 10.1016/j.jhsa.2022.09.010] [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] [Received: 03/20/2022] [Revised: 08/18/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. METHODS The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. RESULTS Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. CONCLUSIONS In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Shirin Modarresi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada; Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - David M Walton
- Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Graham J W King
- Department of Orthopedic Surgery, Western University, London, Ontario, Canada; Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, Ontario, Canada
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Rolls C, Van der Windt DA, McCabe C, Babatunde OO, Bradshaw E. Prognostic factors for persistent pain after a distal radius fracture: a systematic review. HAND THERAPY 2022; 27:123-136. [PMID: 37904895 PMCID: PMC10584063 DOI: 10.1177/17589983221124973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/03/2022] [Indexed: 11/01/2023]
Abstract
Introduction The aim of this systematic review was to synthesize the evidence regarding prognostic factors for persistent pain, including Complex Regional Pain Syndrome (CRPS), after a distal radius fracture (DRF), a common condition after which persistent pain can develop. Methods Medline, Pubmed, Embase, Psychinfo, CINAHL, BNI, AMED and the Cochrane Register of Clinical Trials were searched from inception to May 2021 for prospective longitudinal prognostic factor studies investigating persistent pain in adults who had sustained a DRF. The Quality in Prognostic Studies (QUIPS) tool and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were used to assess the strength of evidence. Results A search yielded 440 studies of which 7 studies met full eligibility criteria. From five studies we found low evidence for high baseline pain or an ulnar styloid fracture as prognostic factors for persistent pain, and very low evidence for diabetes or older age. From two studies, investigating an outcome of CRPS, there was low evidence for high baseline pain, slow reaction time, dysynchiria, swelling and catastrophising as prognostic factors, and very low evidence for depression. Sex was found not to be a prognostic factor for CRPS or persistent pain. Conclusions The associations between prognostic factors and persistent pain following a DRF are unclear. The small number of factors investigated in more than one study, along with poor reporting and methodological limitations contributed to an assessment of low to very low strength of evidence. Further prospective studies, investigating psychosocial factors as candidate predictors of multidimensional pain outcomes are recommended.
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Affiliation(s)
- Catherine Rolls
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Candy McCabe
- School for Health and Social Wellbeing, University West of England, Bristol, UK
| | | | - Elizabeth Bradshaw
- Therapy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Shafiee E, MacDermid J, Farzad M, Karbalaei M. A systematic review and meta-analysis of Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE) measurement properties, translation, and/ or cross-cultural adaptation. Disabil Rehabil 2022; 44:6551-6565. [PMID: 34505793 DOI: 10.1080/09638288.2021.1970250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To critically appraise, summarize, and synthesize the evidence on the psychometric, translation and/or cross-cultural adaptation properties of the Patient-Rated Wrist (and Hand) Evaluation (PRWE/PRWHE). MATERIALS AND METHODS Four electronic databases were searched from 1998 to February 2021. Studies addressing psychometric, translation and/or cross-cultural adaptation properties were included. Two independent reviewers extracted data and assessed methodological quality of the studies using the COSMIN checklist. Where possible, meta-analysis was conducted to pool the estimates of each measurement property. Otherwise, qualitative synthesis was conducted. The overall quality of evidence on each measurement property was provided using GRADE principles. RESULTS Forty-four studies were eligible for data extraction. The PRWE/PRWHE has been translated into 21 languages. The best factor structure was a one-dimensional construct with three unidimensional subscales. High-quality evidence supports very good structural and cross-cultural validity, internal consistency, test-retest reliability, measurement error, and hypothesis testing for construct validity against DASH in wrist and hand injuries. However, low-quality evidence supports acceptable responsiveness property. The minimal clinically important difference for the PRWE/PRWHE was 24 points for patient-level comparisons and 17 for groups. CONCLUSION High-quality evidence supports the use of PRWE/PRWHE as a reliable, valid, and structurally sound questionnaire to assess pain and disability in patients with various wrist and hand injuries. Registration code: CRD42020180250IMPLICATION FOR REHABILITATIONSThe PRWE/PRWHE is a reliable and valid anatomical region-specific measure to assess pain and disability in patients with wrist and hand injuries.Each individual subscale of the PRWE/PRHWE (pain, specific activities, and usual activities) can be used separately as a measure of pain and disability.Change scores less than 9/100 in the total score, should be considered as measurement error, not real change. Changes in the total score between 17 and 24/100 could be assumed as the minimal clinically important change in the condition of patients over time. The PRWE/PRWHE is available in 21 different languages and has been successfully adapted into highly diverse cultures. This point could be considered as one of the merits of using PRWE/PRWHE in clinical settings in multi-lingual and multi-cultural countries, when clinicians need a psychometrically sound patient reported wrist/hand measure..
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Affiliation(s)
- Erfan Shafiee
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Joy MacDermid
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada
| | - Maryam Farzad
- School of physical therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahdieh Karbalaei
- Department of Occupational Therapy, Tehran University of Medical Sciences, Tehran, Iran
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Valenzuela-Fuenzalida J, Román-Veas J, Campos-Jara C. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022; 108:103323. [PMID: 35589085 DOI: 10.1016/j.otsr.2022.103323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/25/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to determine whether surgical treatment is more effective than conservative treatment in terms of functional outcomes in elderly patients with distal radius fractures (DRFs). METHODS An electronic search of the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases was performed, from inception until July 2021. The eligibility criteria for selecting studies were randomized clinical trials that compared surgical versus conservative treatment in subjects older than 60 years with DRFs. Two authors independently performed the search, data extraction, and assessed risk of bias (RoB) using the Cochrane RoB tool. RESULTS Twelve trials met the eligibility criteria, and nine studies were included in the quantitative synthesis. For volar plate versus cast immobilization at 1-year follow-up, the mean difference (MD) for PRWE was -5.36 points (p=0.02), for DASH was -4.03 points (p=0.02), for grip strength was 8.32% (p=0.0004), for wrist flexion was 4.35 degrees (p=0.10), for wrist extension was -1.52 degrees (p=0.008), for pronation was 2.7 degrees (p=0.009), for supination was 4.88 degrees (p=0.002), and for EQ-VAS was 2.73 points (p=0.0007), with differences in favor of volar plate. For K-wire versus cast immobilization at 12 months, there were no statistically significant differences in wrist range of motion (p>0.05). CONCLUSIONS There was low to high evidence according to GRADE ratings, with a statistically significant difference in functional outcomes in favor of volar plate versus conservative treatment at 1-year follow-up. However, these differences are not minimally clinically important, suggesting that both types of management are equally effective in patients older than 60 years with DRFs. LEVEL OF EVIDENCE I; Therapeutic (Systematic review and meta-analysis of randomized clinical trials).
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha Street 700, Santiago, Chile.
| | - Felipe Araya-Quintanilla
- Rehabilitation in Health Research Center (CIRES), University of the Americas, Manuel Montt Avenue 948, Santiago, Chile
| | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), University of the Americas, Manuel Montt Avenue 948, Santiago, Chile
| | | | - Juan Valenzuela-Fuenzalida
- Departamento de Ciencias Químicas y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | | | - Christian Campos-Jara
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Fernández Concha Street 700, Santiago, Chile
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Evans DW, Rushton A, Middlebrook N, Bishop J, Barbero M, Patel J, Falla D. Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom. JAMA Netw Open 2022; 5:e2228870. [PMID: 36018591 PMCID: PMC9419019 DOI: 10.1001/jamanetworkopen.2022.28870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain. OBJECTIVE To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021. EXPOSURE Acute musculoskeletal trauma requiring admittance to a major trauma center hospital. MAIN OUTCOMES AND MEASURES A poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results. RESULTS In total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92. CONCLUSIONS AND RELEVANCE A poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.
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Affiliation(s)
- David W. Evans
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Nicola Middlebrook
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jon Bishop
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Marco Barbero
- Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Jaimin Patel
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- University Hospitals Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Babatunde OO, Bucknall M, Burton C, Forsyth JJ, Corp N, Gwilym S, Paskins Z, van der Windt DA. Long-term clinical and socio-economic outcomes following wrist fracture: a systematic review and meta-analysis. Osteoporos Int 2022; 33:753-782. [PMID: 34766193 DOI: 10.1007/s00198-021-06214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED A comprehensive review of studies shows that patients with wrist fracture, aged over 50 years, experience pain and functional limitation long after fracture. This is associated with increased healthcare costs, and reduced quality of life. Understanding factors that predict poor outcomes is important for future healthcare policy and planning. PURPOSE To summarise and appraise evidence on the prognosis and long-term clinical and socio-economic outcomes following wrist fracture among adults aged 50 years and over. METHODS Five databases (MEDLINE, EMBASE, AMED, CINAHL-P and PsycINFO) were comprehensively searched (supplemented by a grey-literature search) from inception till June 2021 for prospective/retrospective cohort studies of patients (≥ 50 years) with a history of wrist fracture and reporting long-term (≥ 6 months) outcomes. Peer study selection, data extraction and risk of bias assessment were conducted. A random effects meta-analysis was used to summarise estimates of pain and function outcomes. RESULTS 78 studies (n = 688,041 patients) were included. Patients report persistent moderate to severe pain (range: 7.5%-62%) and functional limitations (range: 5.5-78%) up to 12-months or later after wrist fracture. Mean Patient-Rated Wrist Evaluation (PRWE) score for pain and function (9 studies, n = 1759 patients) was 15.23 (95%CI 12.77, 17.69) at 6-months to 13-years follow-up. Mean disabilities of the arm, shoulder and hand (DASH) score (9 studies, n = 1346 patients) was 13.82 (95%CI 12.71, 14.93)( at 6- to 17-months follow-up. A 10-20% increase in healthcare encounters in the first 12-months after fracture was observed. Twelve prognostic factors were associated with poor long-term outcomes. CONCLUSION Evidence shows that a high proportion of people aged over 50 years with wrist fracture experience pain and functional limitation > 6 months after fracture. This is associated with increased healthcare costs, and reduced quality of life. Exploratory evidence was found for several candidate prognostic factors. Their predictive performance needs to be investigated further. PROSPERO CRD42018116478.
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Affiliation(s)
- O O Babatunde
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK.
| | - M Bucknall
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - C Burton
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - J J Forsyth
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, ST4 2DF, UK
| | - N Corp
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
| | - S Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Z Paskins
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke on Trent, ST6 7AG, UK
| | - D A van der Windt
- Keele University School of Medicine Staffordshire, Keele, ST5 5BG, UK
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Liew BXW, de-la-Llave-Rincón AI, Scutari M, Arias-Buría JL, Cook CE, Cleland J, Fernández-de-Las-Peñas C. Do Short-Term Effects Predict Long-Term Improvements in Women Who Receive Manual Therapy or Surgery for Carpal Tunnel Syndrome? A Bayesian Network Analysis of a Randomized Clinical Trial. Phys Ther 2022; 102:6534401. [PMID: 35194646 DOI: 10.1093/ptj/pzac015] [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] [Received: 07/13/2021] [Revised: 11/24/2021] [Accepted: 12/27/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this study was to develop a data-driven Bayesian network approach to understand the potential multivariate pathways of the effect of manual physical therapy in women with carpal tunnel syndrome (CTS). METHODS Data from a randomized clinical trial (n = 104) were analyzed comparing manual therapy including desensitization maneuvers of the central nervous system versus surgery in women with CTS. All variables included in the original trial were included in a Bayesian network to explore its multivariate relationship. The model was used to quantify the direct and indirect pathways of the effect of physical therapy and surgery on short-term, mid-term, and long-term changes in the clinical variables of pain, related function, and symptom severity. RESULTS Manual physical therapy improved function in women with CTS (between-groups difference: 0.09; 95% CI = 0.07 to 0.11). The Bayesian network showed that early improvements (at 1 month) in function and symptom severity led to long-term (at 12 months) changes in related disability both directly and via complex pathways involving baseline pain intensity and depression levels. Additionally, women with moderate CTS had 0.14-point (95% CI = 0.11 to 0.17 point) poorer function at 12 months than those with mild CTS and 0.12-point (95% CI = 0.09 to 0.15 point) poorer function at 12 months than those with severe CTS. CONCLUSION Current findings suggest that short-term benefits in function and symptom severity observed after manual therapy/surgery were associated with long-term improvements in function, but mechanisms driving these effects interact with depression levels and severity as assessed using electromyography. Nevertheless, it should be noted that between-group differences depending on severity determined using electromyography were small, and the clinical relevance is elusive. Further data-driven analyses involving a broad range of biopsychosocial variables are recommended to fully understand the pathways underpinning CTS treatment effects. IMPACT Short-term effects of physical manual therapy seem to be clinically relevant for obtaining long-term effects in women with CTS.
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Affiliation(s)
- Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Ana I de-la-Llave-Rincón
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marco Scutari
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), Lugano, Switzerland
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Chad E Cook
- Doctor of Physical Therapy Program, Duke University, Durham, North Carolina, USA
| | - Joshua Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
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Johnson EM, Yoon D, Biswal S, Curtin C, Fox P, Wilson TJ, Carroll I, Lutz A, Tawfik VL. Characteristics of Patients With Complex Limb Pain Evaluated Through an Interdisciplinary Approach Utilizing Magnetic Resonance Neurography. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:689402. [PMID: 35295513 PMCID: PMC8915577 DOI: 10.3389/fpain.2021.689402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
Patients with persistent complex limb pain represent a substantial diagnostic challenge. Physical exam, and tests such as nerve conduction, are often normal even though the patient suffers from severe pain. In 2015, we initiated a team-based approach to evaluate such patients. The approach included physicians from several specialties (Anesthesiology/Pain Medicine, Radiology, Plastic Surgery, Neurosurgery) combined with the use of advanced imaging with Magnetic Resonance Neurography (MRN). This preliminary case series discusses MRN findings identified in patients with previously difficult-to-diagnose peripheral limb pain and describes how this combination of approaches influenced our diagnosis and treatment plans. We extracted demographics, patient characteristics, presenting features, diagnostic tests performed, treatments provided, referral diagnosis and the diagnosis after interdisciplinary team evaluation from patient charts. We evaluated MRN and electrodiagnostic studies (EDX) ability to identify injured nerves. We compared abnormal findings from these diagnostics to patient reported outcome after ultrasound-guided nerve block. A total of 58 patients, 17 males and 41 females, were identified. The majority of patients presented with lower extremity pain (75%) and had prior surgery (43%). The most commonly identified abnormality on MRN was nerve signal alteration on fluid sensitive sequences, followed by caliber change and impingement. Comparing the outcome of diagnostic nerve blocks with abnormal nerve findings on MRN or EDX, we found that MRN had a sensitivity of 67% and specificity of 100% while for EDX it was 45 and 0%, respectively. After interdisciplinary discussion and imaging review, a more specific diagnosis was produced in 78% of evaluated cases opening up additional treatment pathways such as nerve-targeted surgery, which was performed in 36% cases. This descriptive case series demonstrates that a majority of patients evaluated by our team for complex limb pain were women with lower extremity pain resulting from surgery. In addition, an interdisciplinary team evaluation and the use of the moderately sensitive but highly specific MRN imaging modality resulted in a change in diagnosis for a majority of patients with complex limb pain. Future studies investigating patient outcomes after diagnosis change are currently underway based on the findings of this preliminary study.
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Affiliation(s)
- Emily M Johnson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Daehyun Yoon
- Department of Radiology/Musculoskeletal Imaging, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandip Biswal
- Department of Radiology/Musculoskeletal Imaging, Stanford University School of Medicine, Stanford, CA, United States
| | - Catherine Curtin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Ian Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amelie Lutz
- Department of Radiology/Musculoskeletal Imaging, Stanford University School of Medicine, Stanford, CA, United States
| | - Vivianne L Tawfik
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Modarresi S, MacDermid JC, Suh N, Elliott JM, Walton DM. How Is the Probability of Reporting Various Levels of Pain 12 Months After Noncatastrophic Injuries Associated with the Level of Peritraumatic Distress? Clin Orthop Relat Res 2022; 480:226-234. [PMID: 34705736 PMCID: PMC8747485 DOI: 10.1097/corr.0000000000002024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Psychological factors have been shown to be consistent predictors of chronic pain in people with musculoskeletal injuries. However, few prognostic studies have considered multiple risk factors including peritraumatic distress. In addition, previous research has not considered that the associations between peritraumatic distress and pain levels can vary across pain outcomes. QUESTION/PURPOSE To determine whether an easily measurable level of baseline distress is associated with pain levels 1 year after noncatastrophic traumatic injuries when the outcome to be assessed is not normally distributed. METHODS This was a prospective cohort study. The data were captured from two cohorts in London, Ontario, Canada, and Chicago, IL, USA. Participants were adults with acute noncatastrophic (that is, not treated with surgery or hospitalization) musculoskeletal injuries of any etiology with various injury locations (60% [145 of 241] spinal and 40% [96 of 241] peripheral) that presented to local urgent care centers. Other inclusion criteria included English/French speakers and having no other disorder that would affect their pain levels. In total, between the years 2015 and 2018, 241 participants were recruited based on the inclusion criteria. Ninety-three percent (225 of 241) of participants provided baseline data, and of these, 48% (109 of 225) were lost to follow-up in 1 year. Based on a complete case approach, this study included 116 participants who ranged in age from 18 to 66 years and 69% (80) of whom were women. The Traumatic Injuries Distress Scale (TIDS) was used to evaluate distress at baseline (within 4 weeks of injury). The TIDS is a validated, reliable 12-item risk prognosis screening tool that takes less than 3 minutes to complete with questions regarding uncontrolled pain, negative affect, and intrusion/hyperarousal. The minimum and maximum possible scores are 0 and 24, with higher scores indicating higher levels of distress. The Numeric Pain Rating Scale (NPRS) was used to assess the pain level at baseline and again 12 months postinjury. To complete the NPRS, participants rate the severity of their pain on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. NPRS scores of 1 to 3 indicate mild pain, 4 to 6 indicate moderate pain and 7 or higher indicate severe pain. As a preliminary analysis, to assess whether the participants as a group experienced recovery, a paired samples t-test was used to compare NPRS scores at baseline and 12 months. In all, 52% (60 of 116) of participants reported no pain (NPRS = 0), and mean pain intensity scores improved from 4.8 ± 2.1 at baseline to 1.6 ± 1.6 at 12-month follow-up (p < 0.001). Quantile regression was used to describe the association between baseline distress and pain levels 1 year after the injury. This technique was used because it reveals the relationships at different quantiles of the pain outcome distribution. RESULTS The results indicate some people (52% [60 of 116]) recovered regardless of their baseline level of distress (30th quantile of the NPRS: β = 0). However, in those with persisting pain, higher levels of baseline distress are associated with greater levels of pain 12 months after the injury (50th quantile of the NPRS: β = 0.11; p = 0.01; 70th quantile of the NPRS: β = 0.27; p < 0.001; 90th quantile of the NPRS: β = 0.31; p = 0.01). According to this model, with a baseline TIDS score of 5, there is 10% probability that patients will report moderate or greater levels of pain (4 or higher of 10) 12 months later. This probability then increases as the TIDS score increases. For instance, at a score of 13 on the TIDS, the probability of a patient reporting moderate or higher levels of pain increases to 30%, and the probability of reporting severe pain (higher than 6 of 10) is 10%. CONCLUSION Clinicians and surgeons in orthopaedic settings can screen for the presence of peritraumatic distress using the TIDS, which is an easily administered tool that does not require extensive knowledge of psychology, and by using it they can identify those with higher levels of distress who are more likely to have persistent, long-term pain. A score of 4 or less indicates a low risk of persistent pain, a score between 5 and 12 (endpoints included) indicates moderate risk, and a score of 13 or higher indicates high risk. Future studies should investigate whether certain immediate interventions for peritraumatic distress in the aftermath of trauma can decrease the likelihood that a patient will develop chronic pain after injury. As an analysis technique, quantile regression is useful to assess complex associations in many orthopaedic settings in which a certain outcome is expected to occur in most patients leading to non-normally distributed data. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Shirin Modarresi
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C. MacDermid
- School of Physical Therapy, Western University, London, ON, Canada
- Department of Orthopedic Surgery, Western University, London, ON, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Nina Suh
- Department of Orthopedic Surgery, Western University, London, ON, Canada
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - James M. Elliott
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, & the Northern Sydney Local Health District; The Kolling Institute, St. Leonards, NSW, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David M. Walton
- School of Physical Therapy, Western University, London, ON, Canada
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19
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Mahdavi M, Farzad M, Mehta SP, MacDermid JC, Vahedi M, Hosseini SA, Shafiee E, Farhoud AR. Severity of persistent pain and disability can accurately screen for presence of pain catastrophizing and fear of performing wrist movements in individuals with distal radius fracture. Musculoskelet Sci Pract 2022; 57:102474. [PMID: 34773896 DOI: 10.1016/j.msksp.2021.102474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The evidence indicating presence of psychological factors concerns in individuals who report persistent residual pain and disability over a longer term after distal radius fractures (DRF) is emerging but requires further inquiry. OBJECTIVES To examine the associations of persistent wrist pain and disability at 6-months after DRF with the presence of psychological factors. METHODS Eighty-five patients with DRF were evaluated for wrist pain and disability with subscales of Patient-rated wrist evaluation (PRWE), 6-months after the fracture. The associations of wrist pain and disability with these psychological factors at 6-months after DRF were examined using multivariable logistic regression models. The ability of PRWE scores at 6-months after DRF to accurately classify individuals with and without these psychological factors was examined using the area under the receiver operating characteristic curve (AUC). RESULTS Higher PRWE-P scores were significantly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. In addition, higher PRWE-F scores were also highly associated with worse pain catastrophizing, having emotional distress, and fear of performing wrist movements. The PRWE-P or PRWE-F Scores of ≥18/50 showed the best combination of sensitivity and specificity in identifying individuals with pain catastrophizing, emotional distress, and fear of performing wrist movements at 6-months after DRF (AUC values of ≥0.88). CONCLUSION The novel finding of this study is that scores of ≥18/50 PRWE-P or PRWEF can be used to screen for the presence of these psychological factors.
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Affiliation(s)
- Mohammad Mahdavi
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Maryam Farzad
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada; University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saurabh P Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA; Department of Orthopedic Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada; Co-director Clinical Research Lab, Hand and Upper Limb Center, St. Joseph's Health Center, London, Ontario, Canada; Professor Rehabilitation Science McMaster University, Hamilton, ON, Canada.
| | - Mohsen Vahedi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Science, Tehran, Iran.
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada.
| | - Amir Reza Farhoud
- Imam Hospital Complex, Tehran University of Medical Sciences, Joint Reconstruction Research Center, Iran.
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Straatman L, Knowles N, Suh N, Walton D, Lalone E. The Utility of Quantitative CT (QCT) to Detect Differences in Subchondral Bone Mineral Density Between Healthy People and People with Pain Following Wrist Trauma. J Biomech Eng 2022; 144:1131490. [PMID: 35044448 DOI: 10.1115/1.4053594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 11/08/2022]
Abstract
The mechanisms underlying chronic pain development following musculoskeletal trauma are complex and multifactorial. In their search, some researchers are turning to the subchondral bone as a potential contributor to pain due to its vascularity, using a depth-specific imaging technique. However, this technique has been mainly used in the knee. We propose the use of a quantitative computed tomography (QCT) depth-specific analysis to measure subchondral bone following wrist trauma. Ten participants (n=5 post-trauma; n=5 healthy) underwent bilateral CT scans of their wrist accompanied by a calibration phantom with known densities. Average subchondral vBMD was studied at three depths from the subchondral surface (0 to 2.5, 2.5 to 5, 5 to 7.5mm) according to radial articular surface contact in both wrists of each participant. Percentage differences and Cohen's d effect sizes were calculated to analyze bilateral vBMD and vBMD differences between groups. This image-based tool demonstrated subject-specific, depth-specific, and joint-specific measures of vBMD within the wrist. This methodology highlighted the differences between depth-specific vBMD in healthy people and people who have experienced wrist trauma. Overall, the healthy cohort demonstrated higher vBMD across all three depths and both articular surfaces. This imaging technique further distinguished between subchondral cortical and trabecular bone, wherein clinical implications can be drawn from these distinctions in future work. Our study therefore supports the utility of a QCT imaging technique in detecting differences in depth-specific vBMD in the wrist.
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Affiliation(s)
- Lauren Straatman
- Department of Health and Rehabilitation Sciences, Western University; Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre, Western University, Rm. EC1458, 1201 Western Rd.London, Ontario N6G 1H1
| | | | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre; Schulich School of Medicine and Dentistry, Western University
| | - David Walton
- Department of Health and Rehabilitation Sciences, Western University; School of Physical Therapy, Western University
| | - Emily Lalone
- Department of Mechanical and Materials Engineering, Western University; Roth McFarlane Hand and Upper Limb Centre
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Yoon AP, Wang Y, Wang L, Chung KC. What Are the Tradeoffs in Outcomes after Casting Versus Surgery for Closed Extraarticular Distal Radius Fractures in Older Patients? A Statistical Learning Model. Clin Orthop Relat Res 2021; 479:2691-2700. [PMID: 34142664 PMCID: PMC8726533 DOI: 10.1097/corr.0000000000001865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/28/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal radius fractures (DRFs) are one of the most common major fractures. Despite their frequency, the tradeoffs in different outcomes after casting or surgery for closed extraarticular DRFs in older adults are unknown. QUESTIONS/PURPOSES (1) For adults older than 60 years with closed extraarticular DRFs, what are the tradeoffs in outcomes for choosing casting versus surgery? (2) In what settings would surgery be preferred over casting? METHOD This is a secondary analysis of data from the Wrist and Radius Injury Surgical Trial (WRIST), a randomized, multicenter clinical trial that enrolled patients from April 10, 2012 to December 31, 2016. For WRIST, researchers recruited patients older than 60 years who sustained closed extraarticular distal radius fractures from 24 sites in the United States, Canada, and Singapore. We conducted a secondary analysis using data from WRIST, which had longitudinal data from a robust collection of covariates for patients who underwent surgery and casting. Among the 296 patients recruited in the WRIST study, 59% (174) of patients (mean age 71 ± 9 years) with complete sociodemographic data and 12-month follow-up for each primary outcome were included in the main analysis. More patients underwent surgery than casting (72% [126 of 174] versus 28% [48 of 174]). Most sociodemographic variables were similar between the surgery and casting groups, except for age and volar tilt. The surgical cohort was composed of patients randomized to external fixation, closed reduction percutaneous pinning, or volar locking plate internal fixation. The casting cohort consisted of patients who elected to be treated with closed reduction and casting. A tree-based reinforcement statistical learning method was used to determine the best treatment, either surgery or casting, to maximize functional and esthetic outcomes while minimizing pain. Tree-based reinforcement learning is a statistical learning method to build an unsupervised decision tree within a causal inference framework that will identify useful variables and their cutoff values to tailor treatment assignment accordingly to achieve the best health outcome desired. The primary outcome was minimization of pain (12-month Michigan Hand Outcomes Questionnaire pain subdomain score), maximization of grip strength, total ROM (supination and wrist arc of motion), and esthetics (12-month Michigan Hand Outcomes Questionnaire esthetics subdomain score). RESULTS Casting was the best treatment to reduce pain and maximize esthetics, whereas surgery maximized grip strength and ROM. When the patient favored gaining ROM over pain reduction (more than 80:20), surgery was the preferred treatment. When the patient prioritized the importance of grip strength over pain reduction (more than 70:30), surgery was also the preferred treatment. CONCLUSION There are tradeoffs in outcomes after treating patients older than 60 years with closed extraarticular distal radius fractures with casting or surgery. When patients are attempting to balance minimizing pain and improving functional outcomes, unless they desire maximal functional recovery, casting may be the better treatment. Surgery may be beneficial if patients want to regain as much grip strength and ROM as possible, even with the possibility of having residual pain. These findings can be referenced for more concrete preoperative counseling and patient expectation management before treatment selection. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yibo Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Ziebart C, MacDermid J, Bryant D, Szekeres M, Suh N. Hands-Up program: protocol for a feasibility randomised controlled trial of a combined 6-week exercise and education intervention in adults aged 50-65 with a distal radius fracture. BMJ Open 2021; 11:e046122. [PMID: 34330854 PMCID: PMC8327851 DOI: 10.1136/bmjopen-2020-046122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This pilot study will determine the feasibility of recruitment, retention and adherence for the online combined exercise and education programme (Hands-Up) compared with usual care. METHODS AND ANALYSIS The proposed randomised controlled trial will be a pilot feasibility study with a 1:1 randomisation to the Hands-Up programme or usual physical therapy. The programme setting is an online home exercise and education program. Outcome assessments will take place at the Roth|McFarlane Hand and Upper Limb Clinic in London, Ontario, which is a tertiary care academic centre. 74 people aged 50-65 years after distal radius fracture will be recruited. Purposeful recruitment will be conducted to include a sufficient number of men in the study. The Hands-Up program includes both exercise and education. Participants will engage in approximately 45 min of a full-body home exercise routine followed by 30 min of education in an online program. The educational modules will focus on fall prevention, nutrition for osteoporosis and learning about osteoporosis. Participants will engage in the program online, twice a week for 6 weeks. Outcomes will be assessed at baseline, 6 weeks and 3, 6 and 12 months. The primary outcome of the study is feasibility. The study will be considered feasible if participants attend >60% of the sessions, 74 participants are enrolled in 12 months and >75% of participants attend the final study visit. For the secondary outcome, physical and self-report outcomes will be assessed. ETHICS AND DISCUSSION This study has been approved by the institutional ethics review board. The viability of an online exercise and education program for people after distal radius fracture between the ages of 50 and 65 will be evaluated in an attempt to help better prevent, diagnose and manage osteoporosis. This study will be disseminated through peer-reviewed publications, international conferences and social media. TRIAL REGISTRATION NUMBER NCT03997682.
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Affiliation(s)
- Christina Ziebart
- Department of Physical Therapy, Western University, London, Ontario, Canada
| | - Joy MacDermid
- Department of Physical Therapy, Western University, London, Ontario, Canada
- St Joseph's Health Centre, London, Ontario, Canada
| | - Dianne Bryant
- Faculty of Health Sciences and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Nina Suh
- St Joseph's Health Centre, London, Ontario, Canada
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Lannon E, Sanchez-Saez F, Bailey B, Hellman N, Kinney K, Williams A, Nag S, Kutcher ME, Goodin BR, Rao U, Morris MC. Predicting pain among female survivors of recent interpersonal violence: A proof-of-concept machine-learning approach. PLoS One 2021; 16:e0255277. [PMID: 34324550 PMCID: PMC8320990 DOI: 10.1371/journal.pone.0255277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/14/2021] [Indexed: 11/21/2022] Open
Abstract
Interpersonal violence (IPV) is highly prevalent in the United States and is a major public health problem. The emergence and/or worsening of chronic pain are known sequelae of IPV; however, not all those who experience IPV develop chronic pain. To mitigate its development, it is critical to identify the factors that are associated with increased risk of pain after IPV. This proof-of-concept study used machine-learning strategies to predict pain severity and interference in 47 young women, ages 18 to 30, who experienced an incident of IPV (i.e., physical and/or sexual assault) within three months of their baseline assessment. Young women are more likely than men to experience IPV and to subsequently develop posttraumatic stress disorder (PTSD) and chronic pain. Women completed a comprehensive assessment of theory-driven cognitive and neurobiological predictors of pain severity and pain-related interference (e.g., pain, coping, disability, psychiatric diagnosis/symptoms, PTSD/trauma, executive function, neuroendocrine, and physiological stress response). Gradient boosting machine models were used to predict symptoms of pain severity and pain-related interference across time (Baseline, 1-,3-,6- follow-up assessments). Models showed excellent predictive performance for pain severity and adequate predictive performance for pain-related interference. This proof-of-concept study suggests that machine-learning approaches are a useful tool for identifying predictors of pain development in survivors of recent IPV. Baseline measures of pain, family life impairment, neuropsychological function, and trauma history were of greatest importance in predicting pain and pain-related interference across a 6-month follow-up period. Present findings support the use of machine-learning techniques in larger studies of post-IPV pain development and highlight theory-driven predictors that could inform the development of targeted early intervention programs. However, these results should be replicated in a larger dataset with lower levels of missing data.
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Affiliation(s)
- Edward Lannon
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma, United States of America
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, United States of America
| | - Francisco Sanchez-Saez
- School of Engineering and Technology, Universidad Internacional de La Rioja, Logroño, Spain
| | - Brooklynn Bailey
- Department of Psychology, The Ohio State University, Columbus, Ohio, United States of America
| | - Natalie Hellman
- Department of Psychology, University of Tulsa, Tulsa, Oklahoma, United States of America
| | - Kerry Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Amber Williams
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Subodh Nag
- Department of Neuroscience and Pharmacology, Meharry Medical Center, Tennessee, United States of America
| | - Matthew E. Kutcher
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Uma Rao
- Department of Psychiatry & Human Behavior, Department of Pediatrics, and Center for the Neurobiology of Learning and Memory, University of California–Irvine, Irvine, California, United States of America
- Children’s Hospital of Orange County, Orange, CA, United States of America
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
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Abstract
Distal radius fractures (DRFs) are among the most common upper extremity injuries. Multiple medical conditions now are evaluated by standardized outcome sets that enable comparability. Recent international working groups have provided consensus statements for outcomes measurement after DRFs. These statements emphasized the growing importance of patient-reported outcome measures as well as traditional measures, including pain assessment, radiographic alignment, performance, and assessment of complications. A standardized instrument and timeline for measuring outcomes following DRFs offers clinicians, researchers, and health care economists a powerful tool. This article reviews the current evidence and provides recommendations for a DRF standardized outcome set.
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Affiliation(s)
- Matthew J Hall
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Peter J Ostergaard
- Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA
| | - Tamara D Rozental
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115, USA.
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Abstract
The role of hand therapy in management of distal radius fractures remains unclear. Some evidence demonstrates that initiating early range of motion and urging patients to return to routine activities of daily living as soon as possible may produce favorable outcomes that are as effective as formal supervised therapy. Extended supervised therapy does not appear to impact outcomes and a single instruction session with a home-based program produces similar results. Although we feel that formal structured therapy may have a role in select high-risk patients, the literature remains unclear on which patients would benefit most from formal supervised therapy.
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Affiliation(s)
- Paul Kooner
- Orthopaedic Surgery PGY1, McGill University, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada
| | - Ruby Grewal
- Division of Orthopaedic Surgery, Roth
- McFarlane Hand and Upper Limb Center, Western University, D0-217, St Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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Farzad M, MacDermid JC, Mehta S, Grewal R, Shafiee E. Early post-immobilization pain at rest, movement evoked pain, and their ratio as potential predictors of pain and disability at six- and 12-months after distal radius fracture. Arch Physiother 2021; 11:6. [PMID: 33641681 PMCID: PMC7919326 DOI: 10.1186/s40945-021-00101-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
Background Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury. Methods This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability. Results Scores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50). Conclusion Chronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy.
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Affiliation(s)
- Maryam Farzad
- Department of Health and Rehabilitation Sciences, Roth McFarlane Hand and Upper Limb Centre, University of Western Ontario, School of Physical Therapy, St. Joseph's Hospital, London, Ontario, Canada. .,Department of Occupational therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Joy C MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada.,Co-director Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada.,Rehabilitation Science McMaster University, Hamilton, ON, Canada
| | - Saurabh Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA.,Department of Orthopedic Surgery, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Ruby Grewal
- Roth
- McFarlane Hand and Upper Limb Center, Department of Surgery, Western University, London, ON, Canada
| | - Erfan Shafiee
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Naugle KM, Carey C, Evans E, Saxe J, Overman R, White FA. The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study. J Headache Pain 2020; 21:138. [PMID: 33272206 PMCID: PMC7712573 DOI: 10.1186/s10194-020-01207-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. METHODS Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1-2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies - Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. RESULTS The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1-2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1-2 weeks predicted persistent PTH classification at 4 months post injury. CONCLUSIONS Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.
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Affiliation(s)
- Kelly M Naugle
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis (IUPUI), 901 West New York St., Indianapolis, IN, 46202, USA.
| | - Christopher Carey
- Department of Kinesiology, School of Health and Human Sciences, Indiana University Purdue University Indianapolis (IUPUI), 901 West New York St., Indianapolis, IN, 46202, USA
| | - Eric Evans
- Department of Health Sciences, School of Health and Human Sciences, IUPUI, 250 University Boulevard, Indianapolis, IN, 46202, USA
| | - Jonathan Saxe
- Trauma Department, Ascension St. Vincent Indianapolis Hospital, 2001 W 86th St, Indianapolis, IN, 46260, USA
| | - Ryan Overman
- Department of Neurology, Indiana University School of Medicine, GH 4700 Neur, IN, 46202, Indianapolis, USA
| | - Fletcher A White
- Department of Anesthesia, School of Medicine, Indiana University, 320 West 15th Street, Indianapolis, IN, 46202, USA.,Stark Neuroscience Research Institute, School of Medicine, Indiana University, 320 West 15th Street, Indianapolis, IN, 46202, USA
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Yoon AP, Wang C, Speth KA, Wang L, Chung KC. Modifiable Factors Associated With Chronic Pain 1 Year After Operative Management of Distal Radius Fractures: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2028929. [PMID: 33337492 PMCID: PMC7749439 DOI: 10.1001/jamanetworkopen.2020.28929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Despite appropriate treatment, many patients who sustain distal radius fractures (DRFs) report persistent wrist pain. Chronic musculoskeletal pain is among the leading health problems in the elderly population associated with significant personal and societal burden. OBJECTIVE To identify modifiable preoperative factors that are significantly associated with developing chronic pain. DESIGN, SETTING, AND PARTICIPANTS This is a secondary analysis of the Wrist and Radius Injury Surgical Trial (WRIST), a randomized multicenter clinical trial of 24 study sites in the United States, Canada, and Singapore that enrolled patients from April 10, 2012, to December 31, 2016. Adults older than 60 years who sustained closed extra-articular DRFs, were treated operatively, and completed 12-month Michigan Hand Outcomes Questionnaires (MHQs) were included in this study. Analysis was conducted from September to December 2019. INTERVENTIONS Volar locking plate internal fixation, external fixation, or percutaneous pinning. MAIN OUTCOMES AND MEASURES 12-month MHQ pain domain score. Inverse probability weighted logistic regression was used to identify factors associated with of chronic pain. RESULTS A total of 146 patients with DRF who were treated operatively and had 12-month MHQ scores met inclusion criteria. The mean (SD) patient age was 68.9 (7.2) years, 128 (87.6%) were women, and 93 (63.7%) were retired. Chronic pain was present in 87 patients (59.6%) and absent in 59 patients (40.4%) at 1-year follow-up. A 1-week delay in surgery was associated with more than triple the odds of developing chronic pain (odds ratio [OR], 3.65; 95% CI, 1.48-9.00), and each 10-point increase in preoperative pain was associated with a 17% increase in the odds of experiencing chronic pain (OR, 1.17; 95% CI, 1.02-1.34). Internal fixation was associated with decreased odds of developing chronic pain compared with the other 2 procedures (OR, 0.29; 95% CI, 0.10-0.90). CONCLUSIONS AND RELEVANCE In this study, preoperative pain, time to surgery, and procedure type were modifiable factors associated with chronic pain 1 year after DRF treated with surgery. Adequate pain control in patients with acute DRFs even before definitive surgical management and earlier fixation for patients requiring surgery may decrease the risk of developing chronic pain. Internal fixation may decrease the risk of chronic pain after DRF surgery, compared with percutaneous pinning or external fixation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01589692.
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Affiliation(s)
- Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Chang Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Kelly A. Speth
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Lu Wang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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Egund L, Önnby K, Mcguigan F, Åkesson K. Disability and Pain are the Best Predictors of Sick Leave After a Distal Radius Fracture in Men. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:656-664. [PMID: 32052265 PMCID: PMC7716915 DOI: 10.1007/s10926-020-09880-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Distal radius fracture often compromises working ability, but clinical implications are less studied in men due to its lower incidence. This study therefore describes sick leave in men with distal radius fracture, specifically exploring the impact of patient- and fracture-related factors. Methods Professionally active men aged 20-65 with distal radius fracture were followed prospectively for 1-year (n = 88). Data included treatment method, radiographic parameters pre/post treatment, complications, health, lifestyle and occupational demand. Patient outcomes were self-reported sick leave; Disability of the Arm, Shoulder and Hand (DASH) score; pain (5 likert scale); SF-36: Physical Component Scale (PCS) and Mental Component Scale (MCS). Results Median sick leave was 4 weeks (IQR 0; 8); almost a third reported taking no sick leave. Categorizing sick leave into 3 groups (0-6, 7-12 and > 12 weeks), men with the longest sick leave had 22 points higher DASH score (p = 0.001) and 5 points lower PCS (p = 0.02) at 1 week and the difference remained over time; they were also older and more often treated surgically. The strongest predictors of length of sick leave were one-week post-fracture DASH score (rs = 0.4, p < 0.001), pain intensity (rs = 0.4, p < 0.001) and PCS (rs = - 0.4, p = 0.002). The correlation between sick leave and pain was even stronger analyzing treatment groups separately (closed reduction and cast rs = 0.56, p = 0.007, surgery rs = 0.42, p = 0.04). Conclusions Self-reported disability, pain and global health measurements as early as 1 week post-fracture are the strongest predictors of length of sick leave regardless of treatment; an important finding easily transferrable to clinical management of distal radius fractures.
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Affiliation(s)
- Lisa Egund
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - Karin Önnby
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
| | - Fiona Mcguigan
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
| | - Kristina Åkesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden.
- Department of Orthopedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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The Neuroimmunology of Chronic Pain: From Rodents to Humans. J Neurosci 2020; 41:855-865. [PMID: 33239404 DOI: 10.1523/jneurosci.1650-20.2020] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic pain, encompassing conditions, such as low back pain, arthritis, persistent post-surgical pain, fibromyalgia, and neuropathic pain disorders, is highly prevalent but remains poorly treated. The vast majority of therapeutics are directed solely at neurons, despite the fact that signaling between immune cells, glia, and neurons is now recognized as indispensable for the initiation and maintenance of chronic pain. This review highlights recent advances in understanding fundamental neuroimmune signaling mechanisms and novel therapeutic targets in rodent models of chronic pain. We further discuss new technological developments to study, diagnose, and quantify neuroimmune contributions to chronic pain in patient populations.
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Doménech-García V, Palsson TS, Boudreau SA, Bellosta-López P, Herrero P, Graven-Nielsen T. Healthy Pain-Free Individuals with a History of Distal Radius Fracture Demonstrate an Expanded Distribution of Experimental Referred Pain Toward the Wrist. PAIN MEDICINE 2020; 21:2850-2862. [PMID: 33146396 DOI: 10.1093/pm/pnaa228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Nociception caused by injuries may sensitize central mechanisms causing expanded pain areas. After recovery, the status of such pain distribution and sensitivity mechanisms is unknown. The present study investigated whether individuals who have fully recovered from a distal radius fracture demonstrate increased pain sensitivity and expanded distribution of pressure-induced pain. DESIGN Cross-sectional single-blinded study. SETTING Clinical setting. SUBJECTS Twenty-three pain-free individuals with a history of painful distal radius fracture and 22 nonfractured, age/gender-matched controls participated in two experimental sessions (day 0, day 1) 24 hours apart. METHODS Pressure pain thresholds (PPTs) were recorded bilaterally at the extensor carpi radialis longus (ECRL), infraspinatus, and gastrocnemius muscles. Spatial distribution of pain was assessed following 60-second painful pressure stimulation at the ECRL (bilateral) and the infraspinatus muscles on the fractured or dominant side. Participants drew pain areas on a body map. After day 0 assessments, prolonged pain was induced by eccentric exercise of wrist extensors on the fractured/dominant side. RESULTS Compared with controls, pressure-induced ECRL pain in the fracture group referred more frequently toward the distal forearm (P < 0.005) on day 0. Both groups showed larger pain areas on day 1 compared with day 0 (P < 0.005), although the fracture group showed a larger relative change between days (P < 0.005). The fracture group showed larger pain areas on the fracture side compared with the contralateral side on both days (P < 0.005). CONCLUSIONS Prolonged pain and recovered prior painful injuries like fractures may sensitize pain mechanisms manifested as expanded pain distribution. Pressure-induced referred pain can be a simple pain biomarker for clinical use.
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Affiliation(s)
- Víctor Doménech-García
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Zaragoza, Spain
| | - Thorvalur S Palsson
- Department of Health Science and Technology, SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Shellie A Boudreau
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Herrero
- Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Zaragoza, Spain
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Kaneko A, Naito K, Obata H, Nagura N, Sugiyama Y, Goto K, Kawakita S, Iwase Y, Kaneko K. Influence of Smoking in the Clinical Outcomes of Distal Radius Fractures. J Hand Microsurg 2020; 14:212-215. [DOI: 10.1055/s-0040-1715425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction There are various studies that reviewed the effect of cigarette smoking in fracture healing process. Nonunion, delayed union, and residual pain are the significant risk factors associated with smoking and fracture healing. Little has been known about the impact of smoking in distal radius fracture healing. We intend to explore in brief the effect of smoking in distal radius fracture healing and comparing it with nonsmokers having the same fracture fixation and analyze the outcomes with respect to fracture healing and return of function.
Materials and Methods Of the total 186 patients, 92 were included in the study with (n = male: 31, female: 61) mean age of 60.2 years. They were divided into two groups: smoking (n = 43) and nonsmoking (n = 49). All had surgical fixation of the distal radius with volar locking plate and started on early mobilization. The range of motion of the wrist, grip, visual analog scale, quick disabilities of the arm and shoulder and hand score, Mayo wrist score, and bone healing period were noted between these two groups and compared with statistical analysis.
Results The mean follow-up period was 8.7 months. There was a significant association of young age and male patients having distal radius fractures in the smoking group (p < 0.05). All fractures healed well in both groups without complications. There was no significant difference between these two groups in terms of range of motion, grasp, bone healing period, and functional outcomes.
Conclusion Despite the well-known fact that, smoking has negative implications in the fracture healing process, we found group of patients (smoking and nonsmoking) with distal radius fractures treated by volar locking plates healed well with good radiological union and excellent functional outcome There is no significant influence of smoking in distal radius fracture fixation.
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Affiliation(s)
- Ayaka Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - So Kawakita
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan
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Sgromolo NM, Cancio JM, Rhee PC. Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study. J Wrist Surg 2020; 9:345-352. [PMID: 32760614 PMCID: PMC7395840 DOI: 10.1055/s-0040-1712504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Background Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures. Methods A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture. The same exercises done in the control group were performed by the BFR group with a restrictive tourniquet in place. Patients were followed with serial radiographs to ensure fracture stability. Outcome measures included wrist range of motion, grip strength, pinch strength, visual analog scale (VAS) pain scores at rest and during activity, patient rated wrist evaluation scores (PRWE), and disabilities of the arm, shoulder, and hand scores. Results Nine patients were randomized and enrolled within the BFR group ( n = 5) and control ( n = 4) groups. Patients within the BFR group had a significantly greater reduction in pain with activity over the course of the rehabilitation program. Additionally, the BFR group had a significant improvement in PRWE scores during the 8-week rehabilitation program. There was no difference in radiographic measures after initiation of BFR, and all patients tolerated therapy without noted complications. Conclusion BFR therapy is safe and well tolerated after operatively treated distal radius fractures. The addition of BFR therapy can result in quicker reduction in pain with activity and improvement in patient disability when used early following operative management of a distal radius fracture. Level of Evidence This is a Level 1, prognostic study.
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Affiliation(s)
- Nicole M. Sgromolo
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Jill M. Cancio
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio Military Medical Center, JBSA Ft. Sam Houston, San Antonio, Texas
- Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, San Antonio, Texas
| | - Peter C. Rhee
- Division of Hand Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Clinical Investigation Facility, Travis Air Force Base, California
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Tomruk M, Gelecek N, Basçi O, Özkan M. Effects of early manual therapy on functional outcomes after volar plating of distal radius fractures: A randomized controlled trial. HAND SURGERY & REHABILITATION 2020; 39:178-185. [DOI: 10.1016/j.hansur.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/11/2019] [Indexed: 12/19/2022]
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Jodoin M, Rouleau DM, Bellemare A, Provost C, Larson-Dupuis C, Sandman É, Laflamme GY, Benoit B, Leduc S, Levesque M, Gosselin N, De Beaumont L. Moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study. PLoS One 2020; 15:e0226452. [PMID: 32196498 PMCID: PMC7083311 DOI: 10.1371/journal.pone.0226452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/04/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. METHODS Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). RESULTS Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. DISCUSSION These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.
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Affiliation(s)
- Marianne Jodoin
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de psychologie, de l’Université de Montréal, Montreal, QC, Canada
| | - Dominique M. Rouleau
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
| | - Audrey Bellemare
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de psychologie, de l’Université de Montréal, Montreal, QC, Canada
| | | | - Camille Larson-Dupuis
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de psychologie, de l’Université de Montréal, Montreal, QC, Canada
| | - Émilie Sandman
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
| | - Georges-Yves Laflamme
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
| | - Benoit Benoit
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
| | - Stéphane Leduc
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
| | - Martine Levesque
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Hôpital Fleury, Montreal, QC, Canada
| | - Nadia Gosselin
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de psychologie, de l’Université de Montréal, Montreal, QC, Canada
| | - Louis De Beaumont
- Hôpital Sacré-Cœur de Montréal (HSCM), Montreal, QC, Canada
- Département de chirurgie, de l’Université de Montréal, Montreal, QC, Canada
- * E-mail:
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Therapist's practice patterns for subsequent fall/osteoporotic fracture prevention for patients with a distal radius fracture. J Hand Ther 2020; 32:497-506. [PMID: 29705078 DOI: 10.1016/j.jht.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 03/07/2018] [Accepted: 03/17/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional survey. INTRODUCTION Multifactorial risk factor screening and treatment is needed for subsequent falls/osteoporotic fractures prevention (SFOFP), given the elevated risk among patients with distal radius fracture (DRF). PURPOSE OF THE STUDY The primary objective was to describe hand therapists' knowledge and clinical practice patterns for assessment, treatment, referral, and education with respect to SFOFP for patients with DRF older than 45 years. Secondary objective was to explore therapist's preferences in content and delivery of knowledge translation tools that would support implementation of SFOFP. METHODS A cross-sectional multinational (Canada, the United States, and India) survey was conducted among 272 therapists from August to October 2014. Completed surveys were analyzed descriptively. RESULTS Surveys were completed by 157 therapists. Most respondents were from the United States (59%), certified hand therapists (54%), and females (87%). Although 65%-90% believed that they had knowledge about SFOFP assessment, treatment, and referral options, 55% did not include it in their routine practice for patients with DRF. Most assessed medication history (82%) and never used a Fracture Risk Assessment Tool (90%) or lower extremity muscle strength testing (54%) to identify those at risk of secondary fractures. With respect to treatment, approximately 33% always used upper extremity muscle strengthening exercises. Most reported rarely (sometimes to never) using balance (79%), lower extremity muscle strengthening (85%), bone strengthening (54%), or community-based physical activity (72%) programs. Similarly, when surveyed about patient education, therapists rarely (sometimes to never) advised patients about web-based resources (94%), regular vision testing (92%), diet for good bone health (87%), bone density evaluation (86%), footwear correction (73%), and hazard identification (67%). Most hand therapists were interested to receive more information on SFOFP for patients with DRF. Nearly one-half preferred to have Web sites for patients, and two-fifth were in favor of pamphlets for patients. CONCLUSION Current practice patterns reveal care gaps and limited implementation with respect to SFOFP for patients with DRF. Future research should focus on web-based educational/knowledge translation strategies to promote implementation of multifactorial fall risk screening and hand therapist's engagement in SFOFP for patients with DRF.
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Abstract
During the protective phase of treatment, therapy for hand and wrist injuries in athletes is similar to the plan of care provided to all patients. The nuances in the care provided to athletes become apparent during the transition to the postprotective phase of rehabilitation when the focus has shifted to return to play. Therapy following a sports injury should address the individual needs of the athletes in their everyday lives as well as the specificity of their training and sports-specific activities. The factors that influence return to play are discussed.
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Affiliation(s)
- Jane M Fedorczyk
- Center for Hand and Upper Limb Health and Performance, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, 901 Walnut Street, Suite 600, Philadelphia, PA 19107, USA.
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Dilek B, Ayhan C, Yagci G, Yakut Y. Effectiveness of the graded motor imagery to improve hand function in patients with distal radius fracture: A randomized controlled trial. J Hand Ther 2019; 31:2-9.e1. [PMID: 29122370 DOI: 10.1016/j.jht.2017.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Single-blinded randomized controlled trial. INTRODUCTION Pain management is essential in the early stages of the rehabilitation of distal radius fractures (DRFx). Pain intensity at the acute stage is considered important for determining the individual recovery process, given that higher pain intensity and persistent pain duration negatively affect the function and cortical activity of pain response. Graded motor imagery (GMI) and its components are recent pain management strategies, established on a neuroscience basis. PURPOSE OF THE STUDY To investigate the effectiveness of GMI in hand function in patients with DRFx. METHODS Thirty-six participants were randomly allocated to either GMI (n = 17; 52.59 [9.8] years) or control (n = 19; 47.16 [10.5] years) groups. The GMI group received imagery treatment in addition to traditional rehabilitation, and the control group received traditional rehabilitation for 8 weeks. The assessments included pain at rest and during activity using the visual analog scale, wrist and forearm active range of motion (ROM) with universal goniometer, grip strength with the hydraulic dynamometer (Jamar; Bolingbrook, IL), and upper extremity functional status using the Disability of the Arm, Shoulder and Hand Questionnaire, and the Michigan Hand Questionnaire. Assessments were performed twice at baseline and at the end of the eighth week. RESULTS The GMI group showed greater improvement in pain intensity (during rest, 2.24; activity, 6.18 points), wrist ROM (flexion, -40.59; extension, -45.59; radial deviation, -25.59; and ulnar deviation, -26.77 points) and forearm ROM (supination, -43.82 points), and functional status (Disability of the Arm, Shoulder and Hand Questionnaire, 38.00; Michigan Hand Questionnaire, -32.53 points) when compared with the control group (for all, P < .05). CONCLUSION The cortical model of pathological pain suggests new strategies established on a neuroscience basis. These strategies aim to normalize the cortical proprioceptive representation and reduce pain. One of these recent strategies, GMI appears to provide beneficial effects to control pain, improve grip strength, and increase upper extremity functions in patients with DRFx.
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Affiliation(s)
- Burcu Dilek
- Department of Physical Therapy and Rehabilitation, Istanbul Medipol University, Istanbul, Turkey.
| | - Cigdem Ayhan
- Physiotherapy and Rehabilitation Department, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Gozde Yagci
- Physiotherapy and Rehabilitation Department, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Yavuz Yakut
- Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
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Miller L, Ada L, Crosbie J, Wajon A. Pain in the Post-Operative Week Predicts Pain and Hand Use Twelve Weeks after Proximal Phalangeal Fracture Fixation. J Hand Surg Asian Pac Vol 2019; 24:462-468. [PMID: 31690187 DOI: 10.1142/s2424835519500607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The purpose of this study was to determine whether baseline characteristics predict outcomes twelve weeks after open reduction and internal fixation of proximal phalangeal fracture. Methods: A cohort of patients (n = 48, mean 35 years; SD 11) commencing outpatient rehabilitation within one week of surgery were reviewed. Outcomes of interest were active PIP extension; active total range of motion; pain at rest; comprehensive pain; strength; and hand use (reported difficulty performing specific activities such as turning a door handle, as well as usual activities including housework and recreation) at twelve weeks. Possible predictors included which finger is injured, whether the fracture is intra or extra-articular, whether the dominant or non-dominant hand is injured and/or how much pain is experienced in the first post-operative week. Multiple linear regression was performed to produce a model of the prediction for each outcome of interest at Week 1 (baseline). Results: Results from multivariate linear regression analyses suggest that pain at rest at baseline was significantly predictive of pain at rest (OR = 1.25, 95% CI = 1.06-1.47), p = 0.01), comprehensive pain (OR = 3.18, 95% CI = 1.47-6.84, p = 0.01), and hand use (OR = 2.38, 95% CI = 1.18-4.80, p = 0.02) twelve weeks after open reduction and internal fixation of proximal phalangeal fracture. The turning point on the receiver-operator characteristic curve of false versus true risk (AUC = 0.94, p = 0.04) indicated that at least a score of 4.5 on the 10 cm visual analogue scale for baseline resting pain was needed for significant likelihood of reduced hand use. Which finger was injured, location of fracture and side of injury were not predictive of any outcomes. Conclusions: Moderate to high levels of resting pain in the week following surgery for proximal phalangeal fracture is predictive of pain and hand use at twelve weeks. Moderate to high levels of resting pain should be recognised as unusual, and could be targeted in rehabilitation. Further prospective studies are needed to determine whether early identification and targeted intervention to reduce pain improves outcomes at 12 weeks.
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Affiliation(s)
- Lauren Miller
- Hand Therapy Unit, Sydney Hospital, Sydney, Australia
| | - Louise Ada
- The University of Sydney, Faculty of Health Sciences, Sydney, Australia
| | - Jack Crosbie
- University of Western Sydney, School of Physiotherapy, Campbelltown, Australia
| | - Anne Wajon
- Macquarie University, Faculty of Medicine and Health Sciences, North Ryde, Australia
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Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract 2019; 43:96-102. [PMID: 31374477 DOI: 10.1016/j.msksp.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.
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Affiliation(s)
- Shirin Modarresi
- Health & Rehabilitation Science, Western University, London, ON, Canada.
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada; School of Physical Therapy, Western University, London, ON, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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Efficacy of Compression Gloves in the Rehabilitation of Distal Radius Fractures: Randomized Controlled Study. Am J Phys Med Rehabil 2019; 97:904-910. [PMID: 29994792 DOI: 10.1097/phm.0000000000000998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the outcomes of wearing made-to-measure compression gloves after distal radius fracture. DESIGN In a randomized controlled trial, adults who were about 6 wks post distal radius fracture were recruited and divided into a comparison control group (n = 15), who received standard rehabilitation twice a week for half an hour, and an intervention group (n = 17), who additionally used compression gloves. All treatments were conducted at a single rehabilitation clinic. Outcomes assessed were wrist and finger range of motion, grip strength, swelling, pain, and activities of daily living (using the Patient Rating Wrist Evaluation). The intervention group underwent additional objective dynamic assessments of range of motion with and without the gloves. RESULTS The intervention group demonstrated reduced swelling, pain, and analgesic use; increased wrist range of motion; better scores for specific hand functions; and greater participation in activities of daily living compared with the comparison group. CONCLUSION This randomized controlled trial shows that using compression gloves during the rehabilitation phase after distal radius fracture improves daily functioning and reduces adverse symptoms. These improvements, which are important in their own right, are also expected to aid in preventing the development of chronic conditions and disability. EVIDENCE LEVEL II Un-blinded prospective comparative study.
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Ziebart C, Nazari G, MacDermid JC. Therapeutic exercise for adults post-distal radius fracture: An overview of systematic reviews of randomized controlled trials. HAND THERAPY 2019. [DOI: 10.1177/1758998319865751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
| | - Goris Nazari
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, Canada
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada
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Abstract
Objective: This mixed methods study analyzed the factors that led to a fall in a cohort of patients with distal radius fracture (DRF). Methods: A sample of 1,453 patients (430 men; 1,023 women; age range: 18-89 years) supplemented by new interview data from 29 patients (19 women) were examined. Chi-square and descriptive analysis of quantitative data and descriptive thematic analysis of qualitative data were compared to determine data convergence and divergence. Results: A higher number of DRF were observed in the 45- to 64-year-old group (44%), employed people (48%), in winter months (41%), and in low-energy fractures (75%). Themes emerged from qualitative data on the cause of the fracture, including environmental factors, behavioral factors, physical factors, and sports activities. Conclusion: Reasons for DRF are multifactorial. Preventive strategies with an emphasis on environmental and behavioral factor modifications are likely to decrease the number of DRF.
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Radiographic Thresholds With Increased Odds of a Poor Outcome Following Distal Radius Fractures in Patients Over 65 Years Old. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Persistent Pain After Wrist or Hand Fracture: Development and Validation of a Prognostic Model. J Orthop Sports Phys Ther 2019; 49:28-35. [PMID: 30208793 DOI: 10.2519/jospt.2019.8342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide, the incidence of wrist fracture is increasing. There are currently no externally validated prognostic models to inform early decision making for these patients. OBJECTIVES To develop and validate a prognostic model from a comprehensive range of candidate prognostic factors that can identify patients who are at risk of developing persistent pain following wrist or hand fracture. METHODS We developed and validated a prognostic model using secondary data derived from a prospective cohort study (n = 715), with recruitment sites in 3 metropolitan hospitals in Sydney, Australia. The primary outcome was persistent pain 4 months following the injury. The current study used a backward stepwise regression analysis to develop the model in 2 hospitals (n = 408) and externally validate it in a third hospital (n = 307). To determine the accuracy of the model, we assessed calibration and discrimination in accordance with the PROGnosis RESearch Strategy framework. RESULTS Complete data were available for 95% of the cohort. Of 14 candidate variables, the final model contained 2 prognostic factors: patient age and pain intensity reported at initial presentation. The area under the receiver operating characteristic curve was 0.63 (95% confidence interval: 0.56, 0.69) in the development sample and 0.61 (95% confidence interval: 0.51, 0.70) in the validation sample. The model systematically overestimated risk (intercept, -1.13; slope, 0.73). CONCLUSION We developed and externally validated a prognostic model to predict persistent pain 4 months after a wrist or hand fracture. Future studies are needed to assess whether the accuracy of this model can be improved by updating and validating it in local settings. LEVEL OF EVIDENCE Prognosis, level 1b. J Orthop Sports Phys Ther 2019;49(1):28-35. Epub 12 Sep 2018. doi:10.2519/jospt.2019.8342.
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Farzad M, Layeghi F, Hosseini A, Dianat A, Ahrari N, Rassafiani M, Mirzaei H. Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study. J Hand Surg Asian Pac Vol 2018; 23:554-561. [DOI: 10.1142/s2424835518500571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF). Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. The Beck depression inventoryshort form (BDI), State-Trait Anxiety Inventory, and Numerical pain rating scale were used to determine the patients’ psychological features and pain intensity at the base line and 8 weeks after the fracture. Results: CRPS I developed in 15 (25%) patients after eight weeks and just last in 10 (16.67%) patients after one year. No difference was found between the two groups (CRPS and non-CRPS group) in terms of state (STAI-I) and trait (STAI-II) anxiety, and BDI score. Pain at the base line was the most important risk factor in developing CRPS (odds ratio [OR] =1.52; 95% CI). Conclusions: After fracturing the distal radius, patients who have high pain intensity have a higher risk of developing CRPS I. To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions.
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Affiliation(s)
- Maryam Farzad
- Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fereydoun Layeghi
- Department of Clinical Science, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Hosseini
- Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Al Dianat
- Medicine Department, Iran University of Medical Sciences, Tehran, Iran
| | - Nadiyeh Ahrari
- Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Rassafiani
- Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hooshang Mirzaei
- Department of Occupational Therapy, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Truong JL, Doherty C, Suh N. The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review. Hand (N Y) 2018; 13:509-515. [PMID: 29020814 PMCID: PMC6109905 DOI: 10.1177/1558944717735945] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. METHODS A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. RESULTS There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. CONCLUSIONS Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.
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Affiliation(s)
- Jessica L. Truong
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Chris Doherty
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Nina Suh
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada,Nina Suh, Department of Surgery, University
of Western Ontario, 900 Richmond Street, London, Ontario, Canada N6A 4V2.
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Abstract
An estimated 116 million Americans suffer from chronic pain, at a cost of over $600 billion per year, or roughly $2000 per person per year. In this Viewpoint, the authors highlight the challenges of the current opioid epidemic and outline strategies that the physical therapy profession may adopt to be part of the solution. These strategies include facilitating and providing patient education, early access to physical therapy services, and the promotion of health, wellness, and prevention. J Orthop Sports Phys Ther 2018;48(5):349-353. doi:10.2519/jospt.2018.0606.
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Karagiannopoulos C, Sitler M, Michlovitz S, Tucker C, Tierney R. Responsiveness of the active wrist joint position sense test after distal radius fracture intervention. J Hand Ther 2017; 29:474-482. [PMID: 27769839 DOI: 10.1016/j.jht.2016.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION The active wrist joint position sense (JPS) test has been determined to be a clinically useful test for assessing wrist sensorimotor (SM) status after distal radius fracture (DRF). Its responsiveness is yet to be determined. PURPOSE OF THE STUDY Primary study aim was to determine the active wrist JPS test responsiveness to detect change in wrist SM status at 8 and 12 weeks after DRF treatment intervention. Secondary aims were to compare group (nonsurgical, surgical, high, and low pain) test responsiveness; compare pain-level group participants test scores; determine the relationship between test minimal clinically important difference (MCID) value and function; compare functional outcomes across assessment times; and determine the Patient Global Impression of Change Scale intrarater reliability. METHODS A total of 33 male and female participants were tested at baseline, 8, and 12 weeks after nonsurgical (n = 13) and surgical (n = 20) DRF treatment interventions. Distribution-based analysis encompassed both group- (ie, effect size, standardized response mean) and individual-based (ie, minimum detectable change) statistical indices. Anchor-based analysis determined the MCID value by linking test scores to the Patient Global Impression of Change Scale. RESULTS The active wrist JPS test is highly responsive based on effect size (8 weeks = 1.53 and 12 weeks = 2.36) and standardized response mean (8 weeks = 1.57 and 12 weeks = 2.14). Statistically significant minimum detectable change values were 4.28° and 4.94° at 8 and 12 weeks, respectively. Clinically meaningful MCID values were 5.00° and 7.09° at 8 and 12 weeks, respectively. Between treatment type and pain-level group responsiveness levels were not significantly different. High-pain participants demonstrated significantly greater JPS deficit. Test MCID values and function were significantly associated. DISCUSSION This is the first study to determine the active wrist JPS test responsiveness as reflected by its group- and individual-based statistical indices following DRF surgical and non-surgical interventions among low- and high-pain level participants. The statistical analysis approach, which was used to determine the aforementioned variables of the active wrist JPS test, is consistent with current research. This study's strengths included its design, methodology, and statistical approach. The study findings must be interpreted, however, within the content of several methodological limitations. CONCLUSIONS The active wrist JPS test was determined to be highly responsive to detect wrist SM status change at 8 and 12 weeks regardless of treatment type or pain level. Clinicians can use this test with confidence to measure clinically meaningful SM impairment after DRF treatment. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
| | - Michael Sitler
- Office of the Provost, Temple University, Philadelphia, PA, USA
| | - Susan Michlovitz
- Department of Rehabilitation and Regenerative Medicine, Program in Physical Therapy, Columbia University, New York, NY, USA
| | - Carole Tucker
- Department of Physical Therapy, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ryan Tierney
- Department of Kinesiology, College of Public Health, Temple University, Philadelphia, PA, USA
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Jodoin M, Rouleau DM, Gosselin N, Benoit B, Leduc S, Laflamme Y, Larson-Dupuis C, De Beaumont L. Comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated limb fracture. Injury 2017; 48:1927-1931. [PMID: 28693815 DOI: 10.1016/j.injury.2017.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/22/2017] [Accepted: 06/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated limb fracture (ILF) when compared to a matched cohort group with no mTBI (control group). PATIENTS AND METHODS All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. RESULTS A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper limb fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49days, SD: 34.9), compared to the control group (p<0.0001; mean difference 2.8, 95% confidence interval 1.8-4.0). Correlational analyses show no significant association between the level of pain and factors such as age, sex, severity of post-concussive symptoms, and worker compensation. CONCLUSIONS Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.
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Affiliation(s)
- Marianne Jodoin
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Benoit Benoit
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Stéphane Leduc
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Yves Laflamme
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Camille Larson-Dupuis
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada.
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