Early Psychological and Social Factors Explain the Recovery Trajectory After Distal Radial Fracture.
Jayakumar P., Teunis T., Vranceanu AM., Lamb S., Ring D., Gwilym S.
BACKGROUND: This prospective study identified the association of demographic, injury, psychological, and social variables, measured early during recovery, with limitations in function (measured by the Patient-Reported Outcomes Measurement Information System Upper Extremity Physical Function Computer Adaptive Test [PROMIS UE]) at 6 to 9 months after a distal radial fracture. Additionally, we assessed variables associated with the PROMIS UE; the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH); the Patient-Rated Wrist Evaluation (PRWE); and the 3-Level EuroQol 5 Dimensions Index (EQ-5D-3L) over time. METHODS: A total of 364 adult patients (73% female), with a median age of 65 years (interquartile range, 45.5 to 77 years), who sustained an isolated distal radial fracture completed questionnaires at 3 time periods after the fracture: within 1 week, between 2 and 4 weeks, and between 6 and 9 months. We created a multivariable regression model and a generalized least squares random effects model, accounting for multicollinearity using correlation matrices, the variable inflation factor, and the partial R. RESULTS: Multiple variables within a week of the injury correlated with 6 to 9-month limitations in bivariate analysis. Being retired (partial R = 0.19; p < 0.001), using opioids after the fracture (partial R = 0.04; p < 0.001), using antidepressants (partial R = 0.11; p < 0.001), greater pain interference (partial R = 0.03; p = 0.001), and greater pain catastrophization (partial R = 0.04; p = 0.002) within 1 week of the injury were strong predictors of greater limitations (PROMIS UE) at 6 to 9 months in multivariable analysis. Longitudinal analysis of variables over time demonstrated greater pain interference, greater fear of movement, lower self-efficacy, older age, and female sex as strong predictors of limitations. CONCLUSIONS: Recovery from a distal radial fracture is influenced by a series of demographic, psychological, and social variables. Of these factors, being retired, using opioids, using antidepressants, greater pain interference, and greater pain catastrophization within a week of the injury explain the largest amounts of unique variance in self-perceived upper-extremity physical function. Evaluating the impact of change in variables over time underlined the influence of pain interference as well as the influence of fear of movement and self-efficacy (or resiliency) on limitations in physical function and general health. These findings have important implications for identifying individuals who can benefit from behavioral interventions for these psychological factors to optimize recovery. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.