The impact of demographic factors and comorbidities on distal radius fracture outcomes

Background

Despite the prevalence and consequences of distal radius fracture (DRF), there is limited research that analyzes the effects of demographic factors and comorbidities as they relate to pain, perceived disability, and functional outcomes.

Methods

All data for this study were examined retrospectively within an established clinical database. Patients with DRF were evaluated during their first and final visits with a criterion-based numeric pain scale (CR12), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, and a global rate of change scale to assess outcomes of pain, perceived disability, and function, respectively.

Results

The number of days between injury and initial therapy evaluation were inversely correlated with changes in perceived pain and perceived disability (r?=??0.315, p?=?0.000; r?=??0.348, p?=?0.000). In addition, moderate and statistically significant correlations were noted between work status and average CR12 and DASH scores at final re-evaluation (r?=?0.392, p?=?0.000, r?=?0.473, p?=?0.000). No significant relationships were noted between additional demographic factors or comorbidities and pain, perceived disability, or function during statistical analysis.

Conclusions

Patients without diabetes, hypertension, or depression and those who were not smokers had better outcomes in terms of pain, perceived disability, and function in this study. In addition, earlier timing of initial evaluation after injury and full duty work status were significantly related to improvement in pain and perceived disability. Timing of initiation of therapy and return to work are suggested as avenues for future research.     

Predicting grip strength and key pinch using anthropometric data, DASH questionnaire and wrist range of motion

Purpose

The objective of this study was to examine the influence of anthropometric data, occupational manual strain, DASH (disability of arm, shoulder and hand) score and range of motion (ROM) on grip strength and key pinch. An additional goal was to develop models that enable the prediction of hand strength using the aforementioned parameters.

Methods

Normative data generated from a healthy working population (n?=?750) served as basis for the statistical analysis. Prediction models for hand strength were developed using multivariate regression analysis.

Results

Gender, body weight and height, BMI and extension ROM correlate positively, age and DASH score, however, correlate negatively with grip strength and key pinch. Occupational manual strain has no influence on hand strength. The predictive power of the developed models was 68.4?% for grip strength and 57.1?% for key pinch.

Conclusions

The developed models enable the prediction of hand strength using easily obtainable data points. The models will have application in clinical practice, physiological studies, medical evidence and rehab decisions.     

Correlation of low back pain caused by lumbar spinal stenosis and depression in women: a clinical study

Objective:

Low back pain (LBP) due to spinal stenosis may be one of the most debilitating symptoms to decrease the quality of life. The cause and effect association of LBP and depression is vague. Pain may also be a somatization symptom of depression. This is more frequent in the female population. This clinical study was designed to evaluate the correlation between the level of back pain caused by lumbar spinal stenosis and depression in the female population.

Method:

The study included 50 consecutive female patients with spinal stenosis. The stenosis diagnosis is made by neurological examination and neuro-imaging. The study group was psychiatrically evaluated and grouped as those with and without depression. Visual analog scale (VAS), Oswestry disability index (ODI) and Hamilton Depression Scale (HDS) were utilized in initial evaluation of the group.

Results:

Twenty-one patients with lumbar spinal stenosis had depression (DLS Group) and 29 did not (LSS Group). Mean HDS scores were 8.97 and 32.48 for Group LSS and Group DLS, respectively. There was a statistically significant difference between the VAS scores of the groups (the mean VAS scores were 5.6 and 7.6, for groups LSS and DLS, respectively). The mean ODI values for LSS (65.24?±?4.58) and DLS (75.1?±?6.7) groups were also significantly different. In Group DLS, there were positive correlations between ODI and VAS with HDS (p?Conclusion: Our findings indicated a relationship between lumbar spinal stenosis associated pain levels and depression. However, the cause and result relationship still needs to be established yet.     

Depressive symptoms and treatment of women with urgency urinary incontinence

Introduction and hypothesis

Depression is more common in patients with urinary incontinence (UI). Drug or rehabilitation therapy have been shown to be effective in reducing urgency UI (UUI) symptoms, but whether these treatments can ameliorate the negative impact of UUI on the psychological aspects of quality of life is unclear.

Methods

A secondary analysis of an assessor-blinded randomized controlled trial was performed. The number of depressive symptoms was the primary outcome as measured by the Center for Epidemiologic Studies Depression scale (CES-D).

Results

Thirty-six (22 %) subjects had a CES-D score >16 at baseline, the cutoff for having depressive symptoms. A significant association was found between having a CES-D score >16 and lower quality of life related to UI at baseline. The mean CES-D score among those with depressive symptoms at baseline was significantly reduced throughout the study, with a mean of 23.7 at baseline, to 18.3 and 15.2 at the 3-month and 1-year follow-up (p?<?0.001), respectively. The number of participants who had depressive symptoms decreased during the study period only in the physical therapy groups, from 31 at baseline to 28 and 25, at 3 and 12 months, respectively, while there was no such change in the drug group.

Conclusions

Patients with UUI who had depressive symptoms showed significant improvement in their depressive symptoms with treatment over 1 year. This improvement occurred regardless of the type of treatment. This study emphasizes the increasingly recognized problem of undiagnosed depression among middle-aged women with UUI.     

Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation

Purpose

We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation.

Methods

From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7?%) had successful follow-up for a minimum of 2?years. The mean age of patients was 23.7?years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9?months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up.

Results

The mean number of suture anchors was 3.38 (range 2–6) and the mean number of stitches was 6.32 (range 4–10). Four of the 45 cases had recurrence (8.9?%). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P?P?P?>?0.05), but external rotation at the side was significantly decreased (P?=?0.001).

Conclusions

Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.     

The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion

Purpose

The aim of this study was to evaluate the prevalence of depressive symptoms and disability pre-operatively, at 3 months and at 1 year after lumbar spine fusion surgery.

Methods

Data was extracted from a dedicated lumbar spine fusion register, giving 232 patients (mean age 62 years, 158 females) who had undergone instrumented lumbar spine fusion. The frequency of depressive symptoms and disability was evaluated using the Depression Scale (DEPS) and Oswestry Disability Index (ODI).

Results

Depressive symptoms were found in 34, 13, and 15 % of the patients pre-operatively, at 3 months and at 1 year after surgery, respectively. The mean DEPS score decreased from 16.2 to 8.6 (p < 0.001) in patients who had depressive symptoms pre-operatively, and from 6.1 to 3.8 (p < 0.001) in those patients without pre-operative depressive symptoms. The mean ODI values pre-operatively, at 3 months and at 1 year after surgery were 53, 30, and 23, respectively, in patients with pre-operative depressive symptoms and 41, 23, and 20 in those patients without pre-operative depressive symptoms. The differences between the groups were statistically significant at all time points (p < 0.001).

Conclusions

One-third of our patients with chronic back pain undergoing spinal fusion had depressive symptoms pre-operatively. The prevalence of depressive symptoms decreased after surgery. Although disability remained higher in those patients who had reported depressive symptoms pre-operatively, disability did decrease significantly in both groups post-operatively. Thus, there is no need to exclude depressive patients from operation, but screening measures and appropriate treatment practises throughout both pre-operative and post-operative periods are encouraged.     

Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation

Introduction

Patients with orthopaedic trauma experience substantial psychological and physical morbidities. The purpose of this study was to assess depressive symptoms in patients with a distal radius fracture, and to determine whether early use of the wrist after volar plating reduces depressive symptoms as compared with cast immobilisation during the early recovery period.

Materials and methods

Twenty-six patients with a distal radius fracture, who underwent volar plating and were allowed immediate use of the wrist, and 24 patients treated by cast immobilisation for 6 weeks were prospectively compared with respect to depressive symptoms at week 0, and at 2, 6, 12 and 24 weeks after injury, using the Center for Epidemiologic Studies Depression Scale (CES-D). Physical morbidity was assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a pain Numerical Rating Scale (NRS). Multivariate analysis was performed to identify factors that independently predicted CES-D scores at each time point.

Results

No differences in the CES-D scores were found between the volar plating and the cast immobilisation groups, although volar plating group had marginally better CES-D scores at 24 weeks. Multivariate analysis indicated that CES-D scores at each time were independently associated with pain NRS scores at 0 and 24 weeks, and DASH scores at 6 weeks.

Conclusion

Early use of the wrist after volar plating was not found to reduce depressive symptoms as compared with cast immobilisation in the early treatment period following a distal radius fracture. Pain was found to be an important predictor of depression, suggesting that caution is needed to address pain during the early rehabilitation period.     

Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain

Purpose

This longitudinal study investigated long-term effects of a multidisciplinary rehabilitation program consisting of resistance and sensorimotor training, patient education, and stress management over 6 months in patients with chronic low back pain.

Methods

Ninety-six patients with chronic recurrent low back pain performed a multidisciplinary rehabilitation program. We assessed pain-free lumbar spine range of motion (ROM), strength of the lumbar extensor muscles, and pain by visual analog scale (VAS). Furthermore, the Roland–Morris (RM) questionnaire and SF-36 were used. The examinations were performed before and after rehabilitation, and a long-term follow-up was performed after 18 months.

Results

All outcome measurements (ROM, VAS, RM, muscle strength, and SF-36 scores) improved significantly from baseline to the post-rehabilitation evaluation. These improvements were found to persist until a follow-up evaluation 18 months after cessation of the intervention.

Conclusions

Our findings confirm the results of former studies evaluating the short-term effects of multidisciplinary rehabilitation programs. In addition, our data demonstrate that well-balanced outpatient rehabilitation programs may induce persistent improvements in muscle strength, pain, function and quality of life in patients with chronic low back pain.     

Short-term effects of high-intensity laser therapy,manual therapy,and Kinesio taping in patients with subacromial impingement syndrome

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n?=?15), KT?+?EX (n?=?20), MT?+?KT?+?EX (n?=?16), and MT?+?KT?+?HILT?+?EX (n?=?19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT?+?KT?+?EX and HILT?+?MT?+?KT?+?EX groups (p?<?0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p?<?0.05). These differences were significant especially between the groups MT?+?KT?+?EX and KT?+?EX (p?<?0.05) and HILT?+?MT?+?KT?+?EX and KT?+?EX (p?<?0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.     

The influence of shoulder pain on functional limitation,perceived health,and depressive mood in patients with traumatic paraplegia

Objective

To assess whether functional activity, perceived health, and depressive symptoms differ between individuals with traumatic paraplegia with and without shoulder pain.

Design

Cross sectional and comparative investigation using the unified questionnaire.

Setting

Neural Regeneration and Repair Division unit of Taipei Veterans General Hospital in Taiwan.

Participants

Seventy-six patients with paraplegia (23 with and 53 without shoulder pain) who had experienced spinal cord injury at American Spinal Injury Association Impairment Scale T2 to T12 neurologic level (at least 6 months previously).

Outcome measures

Spinal Cord Independence Measure (SCIM), a single item from the Medical Outcomes Study 36-Item Short-Form Health Survey, and Patient Health Questionnaire-9 (PHQ-9) depression scale.

Results

Shoulder pain was prevalent in 30% patients. Patients with shoulder pain had significantly worse perceived health and greater depressive symptoms than those without. No significant difference was found in functional ability between groups. Greater shoulder pain intensity was related to higher depressive scores (r = 0.278, P = 0.017) and lower self-perceived health scores (r = −0.433, P < 0.001) but not SCIM scores (P = 0.342).

Conclusion

Although shoulder pain was unrelated to functional limitation, it was associated with lower perceived health and higher depressive mood levels.     

Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients

Background

Although arthroscopic subacromial decompression (ASD) is a common procedure for treatment of shoulder impingement, few long term results have been published. In this prospective study, we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up.

Patients and methods

We originally reported high patient satisfaction 6 months after ASD for shoulder impingement in 50 prospectively studied patients using the Disability of the Arm Shoulder and Hand questionnaire (DASH) and the Visual Analog Scale (VAS). Patients with associated shoulder disorders were excluded. The surgeons were experienced shoulder arthroscopists. 6 years after surgery, the DASH questionnaire and the VAS were sent to these 50 patients. 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores, 1 patient was lost to follow-up, and another refused to participate. Thus, 46 patients with a mean age of 55 (33–78) years were included in this 6-year evaluation.

Results

The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery.

Interpretation

Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery.Patients with shoulder impingement may have associated conditions such as painful osteoarthrosis of the acromioclavicular joint, degenerative biceps tendon, or rotator cuff tear. There have been few studies describing the long-term results of arthroscopic subacromial decompression (ASD) for patients with pure shoulder impingement, especially from the standpoint of patient satisfaction. The Constant-Murley score (1987) is commonly used; it provides objective information including strength and range of motion. The DASH score reflects the patient''s own experience of disability and is used to study rotator cuff disorders (Norlin and Adolfsson 2008, Björnsson et al. 2010). Pain is the main complaint in shoulder impingement patients. Thus, it is important to compare preoperative and postoperative pain to evaluate the surgical results. The VAS is a validated and widely accepted tool that measures the severity of pain.We have already reported that ASD in properly selected patients with impingement is an operation that gives high patient satisfaction 6 months after surgery when using DASH and VAS as evaluation tools (Bengtsson et al. 2006). We have now evaluated the patients 6 years after surgery.     

Impact of spinal alignment and back muscle strength on shoulder range of motion in middle-aged and elderly people in a prospective cohort study

Purpose

The relationship between spine and shoulder motion has not been well evaluated. The purpose of this study was to clarify the relationships among thoracic kyphosis and lumbar lordosis, spinal range of motion (ROM), spinal alignment and shoulder ROM.

Methods

Evaluation of spinal alignment was prospectively conducted in 317 subjects (114 males and 203 females, the average age: 67 years) who attended a public health checkup. Shoulder ROM with an angle meter and shoulder pain were evaluated. Thoracic kyphosis angle, lumbar lordosis angle, thoracic ROM, lumbar ROM and spinal inclination angle were measured using SpinalMouse^®. The relationships of these factors with grip strength, back muscle strength, physical ability, osteoporosis and body mass index were examined and multivariate logistic regression analysis was performed to identify the risk factors for limited shoulder ROM.

Results

Limited shoulder flexion was found in 35 patients (11 %) and limited abduction in 50 patients (16 %). In multivariate logistic regression analyses adjusted for age, shoulder pain and other parameters, increased thoracic kyphosis angle and increased spinal inclination angle were risk factors for limited shoulder flexion (p < 0.05). Increased thoracic kyphosis angle and weak back muscle strength were also determined as risk factors for limited shoulder abduction (p < 0.05).

Conclusions

This study provides the first evidence that increased thoracic kyphosis, increased spinal inclination and weak back muscle strength are the risk factors for limited shoulder ROM. These results suggest that maintenance of spinal alignment and back muscle strength may be important for better shoulder ROM.     

The effect of psychological status on pain and surgical outcome in patients requiring arthroscopic subacromial decompression

Background

We prospectively investigated the association between pre-operative psychological status and early post-operative shoulder pain and function in patients requiring arthroscopic subacromial decompression for impingement syndrome.

Methods

A consecutive series of patients in 2009/10 completed questionnaires 2?weeks pre-operatively and three and 6?weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively.

Results

Thirty-one patients participated (21 women; 10 men; mean age 54.6?years; age range 21–89?years). Pre-operative anxiety was significantly associated with pre-operative shoulder pain (P?<?0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P?<?0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P?<?0.05) regardless of pre-operative psychological status.

Conclusion

Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. There may be no justification for assessing psychological state in cases of ‘uncomplicated’ impingement syndromes requiring arthroscopic subacromial decompression. Abnormal pre-operative psychological status is not a justifiable reason for delaying or denying this effective operation.     

Microfractures at the rotator cuff footprint: a randomised controlled study

Purpose

Microfractures at the footprint may be a potential additional source of growth factor and enhance the tendon healing at the bone-tendon junction when repairing rotator cuff tears.

Methods

Fifty-seven patients who underwent shoulder arthroscopy for repair of complete rotator cuff tears were randomly divided into two groups, using a block randomisation procedure. Patients underwent microfracture at the footprint in the treatment group. The patients in the control group (n?=?29) did not receive that treatment. All patients had the same post-operative rehabilitation protocol.

Results

The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow-up of two years. At three months from the index procedure, visual analogue scale (VAS), range of motion (ROM) and University of California at Los Angeles (UCLA) and Constant scores were significantly better in group 1 than in group 2 (P?<?.05). At the last follow-up (minimum two years), clinical and functional outcomes were further improved in both the groups but inter-group differences were not significant. No technique-related complications were recorded.

Conclusions

Microfractures at the footprint are simple, safe, inexpensive and effective at producing less pain in the short term in patients who undergo rotator cuff repair, but at two years they do not result in significantly different outcomes, either clinically or at imaging, compared to traditional rotator cuff repair.     

The association of education level on outcome after distal radius fracture

Background

Socioeconomic factors have been found to be predictors of outcome for other ailments. The purpose of this study was to evaluate the association of patient education level on pain and disability after distal radius fracture.

Methods

A series of patients with distal radius fractures (n?=?335) were enrolled into a prospective research registry. Standard demographic information was obtained from patients, including a five-value categorical education variable. After treatment with closed reduction, external fixation, or internal fixation patients were evaluated for pain, function (Disability of the Arm, Shoulder, and Hand score [DASH]), range of motion (ROM), and grip strength at standard intervals until 12 months post-injury. A series of linear mixed effects models were developed to evaluate the relationship between time from injury and education level with each of the outcomes measured.

Results

Complete demographic and 12-month follow-up data were available on 227 patients (75 %). There were neither group differences in mode of injury, severity, nor treatment modality after stratification by education level. Mixed effects model analyses revealed a significant linear association between level of education and measured outcomes at each follow-up point. Overall, each increase in education level demonstrated a doubling of improvement in pain, ROM, grip strength, and DASH score.

Conclusions

Outcome of distal radius fracture depends on acute care and follow-up rehabilitation; however, patient-related factors indicative of socioeconomic status are becoming increasingly relevant as predictors of outcome and should be considered by the orthopaedist.     

The correlation of phrases and feelings with disability

Background

Patient expressions reflect disability and psychological factors. The aim of this study was to list common phrases and feelings in hand surgery practice and to prospectively study the correlation of these phrases and to correlate them with possible associated feelings and disability.

Methods

Eighty-three patients completed the short version of the disabilities of arm, shoulder and hand (QuickDASH) questionnaire to measure disability, the pain self-efficacy questionnaire (PSEQ) to study coping, and a pain scale. The patients also completed the phrases and feelings questionnaire, which list verbal expressions patients often use. Pearson's correlation was used to test the correlation of continuous variables, and independent t test and one-way ANOVA were used for categorical variables. All variables with p?<?0.08 were inserted in a multivariable regression.

Results

There was a large correlation between the individual phrases and feelings questions with PSEQ and QuickDASH. The best model for the combined phrases questionnaire included pain, PSEQ, smoking, and other pain conditions. The best model for the combination of all the feelings questions included PSEQ, pain, and marital status. The best model for QuickDASH included phrases, PSEQ, prior treatment, and working status, with phrases being the strongest factor.

Conclusions

Patients use specific phrases that indicate the magnitude of their disability and the effectiveness of their coping strategies. Providers should respond to these phrases by empathetically acknowledging these aspects of the human illness experience.     

Platelet-rich plasma injections for chronic plantar fasciitis

Purpose

The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma (PRP) injections for treating chronic plantar fasciitis.

Methods

Fourteen consecutive patients with chronic plantar fasciitis receiving three injections of PRP into the plantar fascia were assessed 12 months after the procedure. The modified Roles and Maudsley score and a visual analogue scale (VAS) for pain were used to evaluate the clinical results.

Results

According to criteria of the Roles and Maudsley score, at 12 months of follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3 %), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was significantly decreased from 7.1?±?1.1 before treatment to 1.9?±?1.5 at the last follow-up (p?<?0.01).

Conclusions

In this single-centre, uncontrolled, prospective, preliminary study, results indicate that treating chronic plantar fasciitis with PRP injections is safe and has the potential to reduce pain.