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. 2008 Sep;3(3):271-5.
doi: 10.1007/s11552-008-9098-y. Epub 2008 Mar 29.

Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis

Santiago A Lozano-Calderon  1 , J Sebastiaan Souer, Jesse B Jupiter, David Ring
Affiliations

Psychological differences between patients that elect operative or nonoperative treatment for trapeziometacarpal joint arthrosis

Santiago A Lozano-Calderon et al. Hand (N Y). 2008 Sep.

Abstract

Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of radiographic severity was near significant (p = 0.06). Stepwise multiple linear regression resulted in a model including the CES-D and PCS scores and accounting for 51% of the variability in DASH scores for patients from both cohorts. For both the operative and nonoperative cohorts, a model including CES-D alone accounted for 50% of the variability in DASH scores (p < 0.01). This study suggests that depression, pain anxiety, and pain catastrophizing are strong correlates of arm-specific disability but do not predict election of operative treatment in patients with trapeziometacarpal arthrosis.

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