Short summary

It is well known that patients with low scores on various psycho-social factors have lower functioning, more pain and poorer health related quality of life after treatment and rehabilitation than those with a high score. It is crucial that the factors are identified with a high level of precision, before they are taken into account in health care.The aim is to identify psycho-social factors that can pre-operatively predict functioning in patients.

Rationale

In clinical practice, it is well known that patients with the same diagnosis often end up with different levels of functioning or capacity to handle everyday life activities, even though they undergo the same course of treatment and rehabilitation. Cross-sectional studies with patients with hand-related diagnoses (HRD) have substantiated this difference. In these studies´, it is reported that patients with low scores on various psycho-social factors have lower functioning, more pain and poorer health related quality of life after treatment and rehabilitation than those with a high score. The relationship between psycho-social factors, pain level and functioning is recognized in diagnoses such as muscular trauma, back pain, spinal cord injuries, amputations and strokes. However, there are variations in the strength of the associations. Reviews in the field conclude that psycho-social factors are significant predictors of pain and functioning, although it cannot be concluded how best to predict them. Aspects most commonly reported are depressive thoughts or mood, catastrophic thinking, anxiety about pain, coping abilities and fear avoidance, but a variety of questionnaires are used to measure these aspects, so it is not possible to compare the results. Aspects have been found to be minimally to moderately related to each other. Some studies have investigated if the presence of several psycho-social factors, increases the impact on results such as pain and functioning, which it suggests. However, various combinations of questionnaires have once again been used in the studies.

The link between psycho-social factors and functioning from cross-sectional studies with patients with HRD has led to the conclusion that patients with low scores on psycho-social factors benefit less from health services. Longitudinal studies, however, have shown that patients are likely to benefit from the treatment and rehabilitation itself, regardless of psycho-social factors. It has been found that those who score low on psycho-social factors at the start of rehabilitation have lower functioning than those who score high, and this difference remains unchanged three months later. However, whether this difference in functioning exists before the operation or is due to patients' different levels of coping post-operatively is not known with certainty. A scoping review from 2017, examining the relationship between psychological factors and patient-reported outcomes in patients with HRD, concluded that the majority of published articles were cross-sectional studies without the scientific power to suggest changes in clinical practice. More longitudinal studies with greater power and a follow-up time of at least one year are required to more validly assess the factors that can predict outcome. It is crucial that the factors are identified with a high level of precision and that the questionnaires used have the capacity to discriminate well, before interventions based on them are implemented.

The overall aim is to identify psycho-social factors that can pre-operatively predict functioning in patients with HRD three months after surgery. The intention in the long run is to improve the long-term functioning of patients at risk of a non-optimal result, by offering more individually-based and needs-oriented interventions.

Description of the cohort

Patients aged 18-70 who understand Danish, so that they can respond to the questionnaires used, and who are due to undergo elective surgery in relation to a hand related disorder.

Data and biological material

Questionnaires.

Collaborating researchers and departments

Department of Orthopaedic Surgery, Odense University Hospital

• Consultant Hans Tromborg
• MD Jens Werlinrud