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Cited by 20Orthopedic Surgery and RehabilitationBone fractures and treatmentsMusculoskeletal pain and rehabilitation

Is Use of a Psychological Workbook Associated With Improved Disabilities of the Arm, Shoulder and Hand Scores in Patients With Distal Radius Fracture?

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Goudie, Stuart, Dixon, Diane, McMillan, Gail, Ring, David, McQueen, Margaret·2018·Clinical Orthopaedics & Related Research
DOI 10.1007/s11999.0000000000000095PMC PMC6260104
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Abstract

Background: Symptom intensity and magnitude of limitations correlate with stress, distress, and less effective coping strategies. It is unclear if interventions to target these factors can be used to improve outcomes after distal radius fracture in either the short- or longer term. Questions/purposes: (1) Are there any factors (including the use of a workbook aimed at optimizing psychological response to injury, demographic, radiographic, medical, or psychosocial) associated with improved Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale pain (NRS pain) scores at 6 weeks after management of distal radius fracture? (2) Are any of these factors associated with improved DASH and NRS pain scores at 6 months after management of distal radius fracture? Methods: We conducted a double-blind randomized controlled trial comparing a workbook designed to optimize rehabilitation by improving psychological response to injury using recognized psychological techniques (the LEARN technique and goal setting) versus a workbook containing details of stretching exercises in the otherwise routine management of distal radius fracture. Patients older than 18 years of age with an isolated distal radius fracture were recruited within 3 weeks of injury from a single academic teaching hospital between March and August 2016. During recruitment, 191 patients who met the inclusion criteria were approached; 52 (27%) declined participation and 139 were enrolled. Eight patients (6%) were lost to followup by 6 weeks. The remaining cohort of 129 patients was included in the analysis. DASH scores and NRS pain scores were recorded at 6 weeks and 6 months after injury. Multivariable regression analysis was used to identify factors associated with outcome scores. Results: At 6 weeks after distal radius fracture, when compared with an information-only workbook, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 38 [range, 21-48]; control DASH: 35 [range, 21-53]; difference of medians: 3; p = 0.949) nor NRS pain scores (workbook NRS: 3 [range, 1-5]; control NRS: 2 [range, 1-4]; difference of medians: 1; p = 0.128). Improved DASH scores were associated with less radial shortening (β = 0.2, p = 0.009), less dorsal tilt (β = 0.2, p = 0.035), and nonoperative treatment (β = 0.2, p = 0.027). Improved NRS pain scores were associated with nonoperative treatment (β = 0.2, p = 0.021) and no posttraumatic stress disorder (PTSD) (β = 0.2, p = 0.046). At 6 months, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 11 [range, 5-28]; control DASH: 11 [range, 3-20]; difference of medians: 0; p = 0.367) nor NRS pain scores (workbook NRS: 1 [range, 0-2]; control NRS: 1 [range, 0-2]; difference of medians: 0; p = 0.704). Improved DASH score at 6 months was associated with having fewer medical comorbidities (β = 0.3, p < 0.001) and lower enrollment PTSD (β = 0.3, p < 0.011). Lower NRS pain scores at 6 months were associated with having fewer medical comorbidities (β = 0.2, p = 0.045), lower enrollment PTSD (β = 0.3, p = 0.008), and lower enrollment Tampa Scale for Kinesiophobia (β = 0.2, p = 0.042). Conclusions: Our study demonstrates that there is no benefit from the untargeted use of a psychological workbook based on the LEARN approach and goal-setting strategies in patients with distal radius fracture. Future research should investigate if there is a subgroup of patients with a negative psychological response to injury that benefits from psychological intervention and, if so, how best to identify these patients and intervene. Level of Evidence: Level II, therapeutic study.

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  • Untargeted use of psychological interventions in hand therapy and when self-directed by patients has been shown to demonstrate no benefits.

    “This is important because the untargeted use of psychological interventions in hand therapy and when self-directed by patients has been shown to demonstrate no benefits [89].”

    From Development and usability testing of a web-based and therapist-assisted coping skills program for managing psychosocial problems in individuals with hand and upper limb injuries: Mixed methods study (2020) · cites this paper as [89]

    The Discussion (page not provided) reports no benefit from an untargeted psychological workbook for patients with distal radius fractures, supporting the self-directed workbook portion of the claim. It does not establish that untargeted psychological interventions in hand therapy generally provide no benefit; the finding concerns one workbook in one patient population. (LLM, conf=0.88)

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  1. Barlow JH, Williams B, Wright C. The Generalized Self-Efficacy Scale in people with arthritis. Arthritis Care Res. 1996;9:189-196.
  2. Jerusalem M, Schwarzer R. Self-efficacy as a resource factor in stress appraisal processes. In: Schwartzer R, ed. Self-efficacy: Thought Control of Action. Washington, DC, USA: Hemisphere; 1992:195-213.
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Authors
Goudie, S., Dixon, D., McMillan, G., Ring, D., & McQueen, M.
Affiliations
University of Strathclyde (GB)
ORCID
Venue
Clinical Orthopaedics & Related Research
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-02-07
Volume
476
Issue
4
Pages
832-845
ISSN
0009-921X (ISSN-L)
DOI
10.1007/s11999.0000000000000095
PMC
PMC6260104
OpenAlex
W2803012703
Cited by
20
References
59
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 3 · 2019: 3
FWCI
2.60
Type
journal article
Language
en
Open access
Locations
  • Clinical Orthopaedics and Related Research (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Orthopedic Surgery and Rehabilitation
  • Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
distal radius fracture, goal setting, DASH score, pain, psychological response to injury, radial shortening, dorsal tilt, wrist range of motion, patient education
MeSH terms
Healthy Lifestyle, Adaptation, Psychological, Adolescent, Adult, Aged, Aged, 80 and over, Arm, Disability Evaluation, Double-Blind Method, Exercise Therapy, Female, Hand, Humans, Male, Middle Aged, Pain Measurement, Patient Education as Topic, Radius Fractures, Scotland, Self Care, Shoulder, Time Factors, Treatment Outcome, Recovery of Function, Self Efficacy, Young Adult, Musculoskeletal Pain

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