Abstract
Study Design
Systematic review.
Introduction and Purpose of the Study
After traumatic hand injury, extensive physical and psychological adaptation is required
following surgical reconstruction. Recovery from injury can understandably be emotionally
challenging, which may result in impaired quality of life and delayed physical recovery.
However, the evidence base for identifying high-risk patients is limited.
Methods
A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present),
PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting
psychological outcomes after acute hand trauma. Subsequent review and selection by
2 independent reviewers identified 19 studies for inclusion. These were poor quality
level 2 prognostic studies, cross sectional or cohort in design, and varied widely
in methodology, sample sizes, diagnostic methods, and cutoff values used to identify
psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires
used to identify them were extracted and analyzed.
Results
Patients with amputations or a tendency to catastrophize suffered highest pain ratings.
Persisting symptom presence at 3 months was the best predictor of chronicity. Many
different questionnaires were used for symptom detection, but none had been specifically
validated in a hand trauma population of patients. Few studies assessed the ability
of selection tools to predict patients at high risk of developing adverse psychological
outcomes.
Discussion and Conclusion
Despite a limited evidence base, screening at 3 months may detect post-traumatic stress
disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention
and improved treatment outcomes.
Level of Evidence
Level 4.
Keywords
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JHT Read for Credit
Quiz: #502
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The study design is
- a.RTCs
- b.prospective
- c.a systematic review
- d.a case series
- a.
- #2.The best indicator of chronicity was ____________ post event
- a.symptoms at 3 months persistent
- b.persistent symptoms at 3 weeks
- c.intensity of symptoms at 1 week
- d.intensity of symptoms at 24 hours
- a.
- #3.High risk patients often present with
- a.anxiety
- b.depression
- c.chronic pain
- d.all of the above
- a.
- #4._____________shapes the recovery trajectory of patients suffering orthopedic injuries
- a.patient's occupational responsibility
- b.therapist's psychological profile
- c.psychological distress
- d.a history of schizophrenia
- a.
- #5.The evidence base for identifying high risk patients is limited
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article Info
Publication History
Published online: February 22, 2017
Accepted:
November 14,
2016
Received in revised form:
November 12,
2016
Received:
June 14,
2016
Identification
Copyright
© 2016 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
