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. 2021 Jan 1;147(1):66e-75e.
doi: 10.1097/PRS.0000000000007441.

Patient Mindset and the Success of Carpal Tunnel Release

Pepijn O Sun  1 , Erik T Walbeehm  1 , Ruud W Selles  1 , Harm P Slijper  1 , Dietmar J O Ulrich  1 , Jarry T Porsius  1 ; Hand Wrist Study Group
Affiliations

Patient Mindset and the Success of Carpal Tunnel Release

Pepijn O Sun et al. Plast Reconstr Surg. .

Abstract

Background: Depression and pain catastrophizing are aspects of the patient's mindset that have been shown to be important in relation to the outcome of carpal tunnel release. However, other factors of the patient's mindset have been understudied, such as treatment expectations and illness perceptions. The aim of the present study was to investigate the influence of these mindset aspects on outcome of carpal tunnel release, in addition to psychological distress and pain catastrophizing.

Methods: A total of 307 patients with carpal tunnel syndrome who visited outpatient hand surgery clinics and who completed online questionnaires regarding demographic and psychosocial characteristics and carpal tunnel syndrome severity were included. The patient mindset was measured with the Patient Health Questionnaire-4, the Pain Catastrophizing Scale, the Credibility Expectancy Questionnaire, and the Brief Illness Perception Questionnaire. Hierarchical linear regression models were used to examine the relation between self-reported severity 6 months after carpal tunnel release, as measured with the Boston Carpal Tunnel Questionnaire, and psychosocial aspects of mindset, adjusting for preoperative Boston Carpal Tunnel Questionnaire score, patient characteristics, and comorbidities.

Results: Independent associations with better self-reported outcome were found for higher treatment expectations (β = -0.202; p < 0.001) and illness comprehensibility (β = -0.223; p < 0.001). The additional explained variance in Boston Carpal Tunnel Questionnaire scores by the patient's mindset was 13.2 percent (psychological distress and pain catastrophizing together, 2.1 percent; treatment expectations and illness perceptions together, 11.1 percent).

Conclusion: Treatment outcome expectations and comprehensibility of illness are both independently associated with the outcome of carpal tunnel release, showing the importance of these aspects of the patient's mindset for the outcome of carpal tunnel release.

Clinical question/level of evidence: Risk, III.

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Conflict of interest statement

Disclosure:Dr. Porsius was supported by a Rubicon Fellowship (446-16-017) from the Netherlands Organisation for Scientific Research (NWO) and by the Medical Delta. The funding sources did not influence the design, analysis, or reporting of this study. The other authors received no financial support for the research, authorship, and/or publication of this article, and declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

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