CORR Insights(®): To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients With Hand Fractures?

Abstract

T he influence of psychological factors on functional outcomes in clinical orthopaedics is becoming increasingly recognized. The World Health Organization has concluded that depression better predicts general health status than angina, asthma, diabetes, or arthritis [5]. In musculoskeletal health, depression has been demonstrated to predict self-reported upper extremity health status for multiple diagnoses [7]. Depression, pain catastrophizing, and other psychological factors are the best available predictors of severity of pain and disability after ACL reconstruction, knee arthroplasty, and minor hand surgery [6, 8, 9]. Psychological symptoms are prevalent and inadequately recognized on clinical impression alone. After orthopaedic trauma, 45% of patients have clinically relevant symptoms of depression [1]; in spine patients, 64% have psychological distress on screening questionnaires [2], and after severe lower limb injuries, 48% of patients screen positive for a likely psychological disorder [3]. Controversies remain regarding the relationships among psychological factors associated with physical impairment (as opposed to perceived disability), the degree to which psychological factors can be modified in the orthopaedic patient, and whether this is practical to achieve. Roh et al. have focused on the role of pain-coping strategies on ROM and grip strength after hand fractures. They found that poor coping skills before surgery, as measured by high catastrophization and anxiety, were associated with weaker grip strength, decreased ROM, and increased disability after surgical treatment for hand fracture in the first 3 months after injury.