Disability and depression after orthopaedic trauma

Sjoerd P F T Nota; Arjan G J Bot; David Ring; Peter Kloen

doi:10.1016/j.injury.2014.06.012

Disability and depression after orthopaedic trauma

Injury. 2015 Feb;46(2):207-12. doi: 10.1016/j.injury.2014.06.012. Epub 2014 Jun 21.

Authors

Sjoerd P F T Nota¹, Arjan G J Bot², David Ring³, Peter Kloen⁴

Affiliations

¹ Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: spnota@hotmail.com.
² Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. Electronic address: a.g.j.bot@gmail.com.
³ Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: dring@partners.org.
⁴ Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. Electronic address: p.kloen@amc.uva.nl.

PMID: 25015790
DOI: 10.1016/j.injury.2014.06.012

Abstract

Introduction: Musculoskeletal injury is a common cause of impairment (pathophysiology), but the correlation of impairment with pain intensity and magnitude of disability is limited. Psychosocial factors explain a large proportion of the variance in disability for various orthopaedic pathologies. The aim of this study is to prospectively assess the relationship between psychological factors and magnitude of disability in a sample of orthopaedic trauma patients in The Netherlands.

Material and methods: One hundred and one adult patients between 1 and 2 months after one or more fractures, tendon or ligament injuries were enrolled. Four eligible patients refused to participate. Thirty-five women and 30 men with an average age of 50 years (range, 22-92 years) completed the follow-up evaluation between 5 and 8 months after their injury and their data was analyzed. The patients completed a measure of disability (the Short Musculoskeletal Function Assessment-Netherlands, SMFA-NL), the Dutch Centre for Epidemiologic Study of Depression-scale (CES-D), the Dutch Impact of Event Scale (SVL), and the Dutch Pain Catastrophizing Scale (PCS) at the time of enrollment and again 5-8 months after injury.

Results: There were moderate correlations between symptoms of depression (CES-D, r=0.48, p<0.001) and symptoms of PTSD (SVL, r=0.35, p=0.004) at enrollment and magnitude of disability 5-8 months after trauma. Catastrophic thinking (PCS) at enrollment and magnitude of disability 5-8 months after trauma showed a small correlation (PCS, r=0.26, p=0.034). The Pain Catastrophizing Scale (Beta=0.29; p=0.049), surgery (Beta=0.26; p=0.034), additional surgery (Beta=0.26; p=0.019) and other pain conditions (Beta=0.31; p=0.009) were the significant predictors in the final model (adjusted R-squared=0.35; p<0.001) for greater disability 5-8 months after trauma.

Discussion and conclusions: In The Netherlands, symptoms of depression measured 1-2 months after musculoskeletal trauma correlate with disability 5-8 months after this trauma. The psychological aspects of recovery from musculoskeletal injury merit greater attention.

Level of evidence: Level II, Prognostic study.

Keywords: Depression; Injury; Orthopaedic trauma; PTSD; Psychosocial.

MeSH terms

Adaptation, Psychological
Adult
Aged
Aged, 80 and over
Analgesics, Opioid / therapeutic use*
Catastrophization / psychology*
Depression / diagnosis*
Depression / etiology
Disabled Persons / psychology*
Female
Follow-Up Studies
Humans
Injury Severity Score
Male
Middle Aged
Musculoskeletal System / injuries*
Musculoskeletal System / surgery
Netherlands / epidemiology
Pain Measurement
Prognosis
Prospective Studies
Quality of Life
Stress Disorders, Post-Traumatic / diagnosis*
Stress Disorders, Post-Traumatic / psychology
Wounds and Injuries / complications
Wounds and Injuries / psychology*
Wounds and Injuries / surgery

Substances

Analgesics, Opioid