Author: Luk, Lai Mei May
Title: Evaluating the predictors of pain and disability for patients treated conservatively after distal radius fracture in Hong Kong : a prospective study
Advisors: Pang, Marco (RS)
Degree: DHSc
Year: 2020
Subject: Radius (Anatomy) -- Fractures
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: 104 pages : color illustrations
Language: English
Abstract: Background: Distal radius fractures (DRFs) are the most common type of fracture of the upper extremity. DRFs are associated with a risk for long-term morbidity, with patient subgroup reporting DRF-related complications including residual pain and functional disabilities. Finding predictors of adverse outcomes can allow early identification of this patient group and formulation of proper rehabilitation regimen. Previous studies have shown that patient characteristics, radiographic parameters, and objectives findings can predict outcomes. Although separate predictors have been revealed in previous literature, studies on multiple predictors as a comprehensive evaluation were limited. Objective: This study aimed to investigate potential predictors of developing chronic pain and disability in DRF patients who were treated conservatively in Hong Kong. The result can enable early identification of patients likely to develop adverse outcomes. Stratified care for DRF patients could allow more targeted use of health care resources. Methods: A prospective study was adopted to evaluate patients with radiographic evidence of an acute unilateral fracture of the distal radius treated by closed reduction and cast immobilization. They received physiotherapy treatment within 2 weeks post-injury. Treatment frequency and duration were dependent on patient's need. The study design required patients to complete three assessments. Information on patient characteristics, post-reduction radiographic parameters, pain level, finger and wrist range of motion, psychological status, and self-perceived disability were taken at initial visit as baseline data. Radiographic parameters, pain level, psychological status, self-perceived disability, and physical outcomes were evaluated again at cast removal and at week 24 post-injury. Radiological imaging of the dorsal tilt, ulnar variance, and radial inclination were measured using digital goniometer through the hospital electronic patient record. The Numeric Rating Scale (NRS) evaluated the average pain level in the recent 1 week. Physical outcomes included finger, wrist, and forearm range of motion. The psychological aspect post-fracture was assessed by Hospital Anxiety and Depression Scale (HADS). The self-rated disability was evaluated by the Disabilities of the Arm, Shoulder, and Hand (DASH) Health Questionnaire. Data recorded at baseline, cast removal, and at week 24 were analyzed by analysis of variance to detect outcome differences. Pearson correlation analysis and forward-stepwise multiple linear regression models were performed to determine the relationship between variables and to find predictors of pain and disability.
Results: Overall, 140 DRF patients (70% women, mean age 67.0±17.9) had completed 6 months of follow-up and were included in the final analysis. Regression analyses showed that the most influential predictors of pain measured at week 24 were NRS (off cast), range of ulnar deviation (off cast), and higher level of occupational demand, which explained 33% of pain variation. On the regression model, HADS (off cast), women, dominant hand injury, and range of ulnar deviation (off cast) explained 26% of the variation of perceived disability at week 24. Conclusions: This study showed that off cast NRS and HADS scores played essential roles in predicting 24-week patient-reported pain and disability, respectively, in people with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.
Rights: All rights reserved
Access: restricted access

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