Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome

Debbie Larson; Ian Nunney; Rebecca Champion; Claire Edwards; Adrian Chojnowski

doi:10.1177/17589983221120839

Brief psychological screening for trapeziectomy: Identifying patients at high risk of a poor functional outcome

Hand Ther. 2022 Dec;27(4):105-111. doi: 10.1177/17589983221120839. Epub 2022 Aug 14.

Authors

Debbie Larson¹, Ian Nunney², Rebecca Champion³, Claire Edwards⁴, Adrian Chojnowski⁴

Affiliations

¹ Physiotherapy Department, Spire Norwich Hospital, Norwich, UK.
² School of Medicine, University of East Anglia, Norwich, UK.
³ Department of Therapeutic Services, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
⁴ Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.

Abstract

Introduction: This study investigates if the psychological subscale from the STarT Back Screening Tool (STarT Psych-sub) identifies patients at high risk of a poor functional outcome after a trapeziectomy based on modifiable psychological factors.

Methods: A total of 83 patients completed the STarT Psych-sub, QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), Patient Evaluation Measure (PEM) and a numeric pain rating scale (NPRS) before trapeziectomy. QuickDASH, PEM and NPRS were completed at 6 weeks, 16 weeks and 1 year after the trapeziectomy.

Results: The STarT Psych-sub stratified 24 patients (29%) as 'high-risk' and 59 (71%) as 'not high-risk' of a poor outcome. The 'high-risk' group reported worse function and pain (QuickDASH = 72.7, PEM = 81.1, NPRS = 8.3) at baseline than the 'not high-risk' group (QuickDASH = 56.1, PEM = 66.4, NPRS = 7.2). This difference remained constant at all time points after the trapeziectomy with 1-year scores on the QuickDASH = 39.6; PEM = 47.1 and NPRS = 3.7 for the 'high-risk' group and QuickDASH = 24.3; PEM = 33.3 and NPRS = 1.9 for the 'not high-risk' group.

Conclusions: Brief psychological screening shows that patients with psychological risk factors experience improved pain and function outcomes following trapeziectomy, however their outcomes are significantly worse than patients who do not have psychological risk factors.

Keywords: Trapeziectomy; functional outcome; hand surgery; osteoarthritis; psychological risk factors.