Highlights
- •Patient baseline levels of depressive symptoms and anxiety do not predict physician referral to hand therapy.
- •Patients with increased depressive symptoms, anxiety, and pain interference require more therapy visits to achieve functional recovery.
- •Mental health status should be considered during hand therapy treatment planning.
Abstract
Introduction
Patients with upper extremity conditions may also experience symptoms of depression,
anxiety, and pain that limit functional recovery.
Purpose of the Study
This study examined the impact of mental health and pain symptoms on referral rates
to therapy and utilization of therapy services to achieve functional recovery among
patients with common hand conditions.
Study Design
This is a retrospective cohort study of patients from one orthopedic center.
Methods
Data extraction provided demographics, the International Classification of Diseases,
10th revision diagnoses, therapy referral, therapy visit counts, treatment goal attainment,
and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression,
Anxiety, and Pain Interference scores. The chi-square test, t-test, and logistic regression analyses assessed associations between baseline PROMIS
depression, anxiety, and pain interference to therapy referral, the number of therapy
visits, and goal attainment.
Results
Forty-nine percent (172/351) of patients were referred to hand therapy. There was
no relationship between three baseline PROMIS scores based on physician referral (t-test P values .32-.67) and no association between PROMIS scores and therapy utilization
or goal attainment (Pearson correlation (r): 0.002 to 0.020, P > .05). Referral to therapy was most strongly associated with having a traumatic
condition (P < .01). Patients with high depression, anxiety, and pain interference scores on average
required one more therapy visit to achieve treatment goals (average visits: 3.7 vs
3.1; 4.1 vs 2.7; 3.4 vs 2.3, respectively). Fewer patients with high depression scores
(50%) achieved their long-term goals than patients with low depression scores (69%,
P = .20).
Conclusions
Patients' baseline level of depressive symptoms and anxiety do not predict referrals
to hand therapy by orthopedic hand surgeons. There is some indication that patients
with increased depressive symptoms, anxiety, and pain interference require more therapy
with fewer achieving all goals, suggesting that mental health status may affect response
to therapy. Therapists may address mental health needs in treatment plans. Future
studies should examine if nonreferred patients with depressive symptoms achieve maximal
functional recovery.
Keywords
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JHT Read for Credit
Quiz: # 809
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.RCTs
- b.case series
- c.prospective cohort
- d.retrospective cohort
- a.
- # 2.The correlation between therapy utilization and the PROMIS was calculated using
- a.the Kappa correlation coefficient
- b.a 2 way ANOVA
- c.a Pearson correlation coefficient
- d.the Student T Test
- a.
- # 3.Raw data were inputted by
- a.patients on an I Pad Mini
- b.therapists on hand-written chart notations
- c.surgeons following patient return to clinic visits
- d.insurance company case workers
- a.
- # 4.In a patient population who had sustained traumatic hand injuries approximately __________ percent were referred to hand therapy
- a.75
- b.50
- c.25
- d.10
- a.
- # 5.The authors concluded that anxiety and depression seldom provoke referrals to hand therapy
- a.not true
- 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: October 14, 2020
Accepted:
October 9,
2020
Received in revised form:
September 17,
2020
Received:
July 30,
2019
Footnotes
Conflict of interest: The authors have no conflicts of interest to declare.
Manuscript Category: Scientific/Clinical Research Report.
Purpose of Research: Clinical research study.
Identification
Copyright
© 2020 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
