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Treatment of posttraumatic stress disorder after work-related hand trauma
Abstract
Posttraumatic stress disorder frequently accompanies severe work-related hand trauma and, when a patient attempts to return to work it can potentially be as debilitating as the hand injury. Four techniques were examined for their effectiveness in the treatment of the symptoms of posttraumatic stress disorder. Confronting and reprocessing of intrusive thoughts, combined with coping skills training, effectively reduced all symptoms except avoidance reactions. An early return to the worksite was useful with those patients who experienced mild avoidance reactions, although many patients were not able to use this. Graded work exposure was a highly successful technique for those patients with moderate avoidance reactions. For those with severe avoidance reactions, on-site job evaluations were used with good success. We believe that actual exposure to the worksite greatly enhances the ability of occupationally hand-injured patients to return to work for their previous employer. An algorithm for treatment is proposed.
... The efficacy of CBT for PTSD has frequently been demonstrated by the significant reduction of PTSD symptom severity. In the last two decades, several PTSD studies have included a measure as well of QoL as a treatment outcome [11][12][13][14][15]. A recent meta-analysis stated that CBT has a moderately strong effect on QoL for those with anxiety disorders [15]. ...
... The participants received a manual describing symptoms and therapy, and complete homework. The treatment was composed of three phases: (a) a psychoeducative intervention regarding PTSD symptoms and the teaching of anxiety management strategies (e.g., diaphragmatic breathing) (sessions 1 to 3); (b) exposure to memories of the traumatic event and cognitive restructuring if needed (sessions 4 to 9); and (c) in vivo exposure to trauma-related stimuli and to avoided situations, with cognitive restructuring if necessary (sessions [10][11][12][13][14][15][16][17][18][19] and relapse prevention (session 20). The participants were interviewed five times throughout the course of therapy, delimitating each CBT step: before therapy (T0), after the first three sessions (T1), at the ninth session (T2), at the end of therapy(T3), and 6 months after therapy (T4). ...
... Standard CBT could be supplemented with strategies focusing specifically on this matter for patients who have experienced a traumatic event in the workplace. For example, Grunert et al. [14] suggest the systematic inclusion of items related to the work environment in graded in vivo exposure exercises. Persistent negative emotions related to the workplace trauma (e.g., anger toward the employer or other employees) also need to be addressed before returning to work. ...
Background: Posttraumatic stress disorder (PTSD) affects the quality of life of employees exposed to a workplace trauma. Cognitive behavioral therapy (CBT) is an effective treatment for PTSD. Less is known, however, about the effect of CBT for work-related PTSD on symptom reduction and QoL enhancement, and how those variables evolve throughout the therapy. Aim: This study aims to thoroughly monitor the evolution of symptoms and quality of life during and after CBT for work-related PTSD. METHODS: Forty-four participants completed structured interviews and questionnaires four times over the course of treatment (at pre-treatment, after the third session, after the ninth session, and posttreatment) and at follow-up (six months). The assessment of quality of life includes the level of current functioning, general quality of life, and work-related quality of life. CBT included 20 weekly individual sessions. Results: Our study showed that all outcomes improved significantly at post-treatment and improvements remained stable over the following six months. 69% of the participants no longer met the criteria for PTSD diagnosis, and half of the sample was able to return to work following psychotherapy. PTSD and QoL significantly improved following each CBT strategy until the end of therapy, and the variables appeared to change synchronously throughout the therapeutic process (i.e., no lagged effect). Conclusions: The findings suggest that work-related trauma victims can benefit from CBT for PTSD. The addition of specific strategies targeting quality of life in CBT for PTSD seems to be not essential for quality of life improvements, but clinicians should consider adding interventions focused on returning to work
... One of them described short-term outcomes for the active treatment versus the waitlist condition (Högberg et al., 2007) and one reported long-term outcomes for the active treatment after the waitlist had also been provided with the intervention (Högberg et al., 2008); the latter study was selected to represent this data set in the RD analysis. Six reports stemmed from the same clinic (Grunert et al., 1989;Grunert, Devine, Smith, et al., 1992;Grunert, Matloub, Sanger, & Yousif, 1990;Grunert et al., 2007;Salyards, 2005;Weis, Grunert, & Christianson, 2012) delivering interventions to treat posttraumatic stress in individuals with industrial injuries. Their study participants were not identical but overlapped to some extent. ...
... Of the 13 studies that included individuals with PTSD or subthreshold PTSD, six used clinician-administered diagnostic interviews (Bender et al., 2016;Difede et al., 2007;Gersons et al., 2000;Högberg et al., 2007Högberg et al., , 2008Rumyantseva & Stepanov, 2008), whereas it remained unclear in the remaining studies how the diagnosis had been established. Most studies used data collection tools that were reliable and valid for assessing trauma-related distress; one study used a single measurement that was not PTSD-specific (Duckworth, 1986), and for three studies (Grunert et al., 1989;Grunert, Devine, Smith, et al., 1992;Grunert et al., 1990) RTW was the only outcome variable. Information on work status-denominated "return to work," "work resumption," or "full working capacity"-was available for 10 studies; only one (Bender et al., 2016) provided a more detailed definition of the term. ...
... Interventions. For most participants, the intervention included some form of exposure-either through revisiting trauma memories or through in vivo exposure to trauma reminders or both (Difede et al., 2007;Gersons et al., 2000;Grunert et al., 1989;Grunert, Devine, Smith, et al., 1992;Grunert et al., 1990;Grunert et al., 2007;Weis et al., 2012). While therapy protocols somewhat varied between studies, these interventions were categorized as TFCBT. ...
The purpose of this study was to summarize the evidence base for interventions targeting individuals with work-related posttraumatic stress disorder (PTSD), to make recommendations for clinicians and administrative decision makers involved in their rehabilitation, and to guide future research in this area. Particular attention was given to studies that were conducted in naturalistic clinical settings or in a workers' compensation claim context. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 11 articles. Study populations included railroad personnel, police officers, disaster workers, and individuals with industrial injuries. Interventions included trauma-focused cognitive-behavioral therapy and eye movement desensitization and reprocessing. Several studies specifically targeted workers who had failed to return to work (RTW) after standard PTSD treatment. The results suggest that psychotherapy interventions are beneficial for helping clients recover from PTSD symptoms and RTW. In studies that reported on work status, RTW rates increased over time and generally lay between 58% and 80% across follow-up time points. Narrative impressions were supplemented by calculation of Risk Differences for individuals working at pretreatment versus posttreatment. Clinical consideration, methodological issues limiting the current body of work, and recommendations for future research are discussed.
... There is some evidence to suggest that early interventions to address psychological symptoms that develop in the acute phase after hand trauma may be beneficial. [8][9][10] However, acute stress reactions do generally resolve without intervention. Moreover, a Cochrane review concluded that early interventions should not be offered to all those exposed to a traumatic event, demonstrating that some early psychological therapies even had a detrimental impact in some individuals. ...
... 58,59 Although 50% of individuals notice an improvement in symptoms after 1 year, 60 subsyndromal symptoms often persist and the majority suffer lifelong recurrences. In this study, depression, anxiety, PTSD, and pain symptoms were correlated, 24,28,29 reflecting wellknown associations, [10][11][12]28 and pain catastrophizing predicted current pain and pain-related anxiety. 23 This trait may be identified using the PCS (Fig. 3) and as it has also previously been linked with depression, disability, and adverse pain outcomes, 61-65 may be a helpful indicator of patients who may particularly benefit from intensive early interventions. ...
Study design:
Systematic review.
Introduction and purpose of the study:
After traumatic hand injury, extensive physical and psychological adaptation is required following surgical reconstruction. Recovery from injury can understandably be emotionally challenging, which may result in impaired quality of life and delayed physical recovery. However, the evidence base for identifying high-risk patients is limited.
Methods:
A PROSPERO-registered literature search of MEDLINE (1946-present), EMBASE (1980-present), PsychInfo, and CINAHL electronic databases identified 5156 results for studies reporting psychological outcomes after acute hand trauma. Subsequent review and selection by 2 independent reviewers identified 19 studies for inclusion. These were poor quality level 2 prognostic studies, cross sectional or cohort in design, and varied widely in methodology, sample sizes, diagnostic methods, and cutoff values used to identify psychological symptoms. Data regarding symptoms, predisposing factors, and questionnaires used to identify them were extracted and analyzed.
Results:
Patients with amputations or a tendency to catastrophize suffered highest pain ratings. Persisting symptom presence at 3 months was the best predictor of chronicity. Many different questionnaires were used for symptom detection, but none had been specifically validated in a hand trauma population of patients. Few studies assessed the ability of selection tools to predict patients at high risk of developing adverse psychological outcomes.
Discussion and conclusion:
Despite a limited evidence base, screening at 3 months may detect post-traumatic stress disorder, anxiety, depression, and chronic pain, potentially allowing for early intervention and improved treatment outcomes.
Level of evidence:
Level 4.
... Cognitive-behavioural therapy, relaxation training, imagery techniques and systematic desensitisation are all helpful treatment strategies to help the patient return to a productive everyday life. 3,5,8e10 Although early PTSD is related to functional outcome after peripheral nerve injury, still little is known about the incidence and predictive factors for posttraumatic stress symptoms, 1,8,9,11,12 how to assess incidence and intensity of post-traumatic psychological stress symptoms and to identify risk factors for early psychological stress. Hence, this study was designed not only to evaluate this prevalence after severe nerve injury of the upper extremity, but also to possibly identify specific risk factors for the development of early psychological stress after a nerve injury. ...
... Earlier research has demonstrated the effectiveness of cognitivebehaviour therapy, group therapy and exposure therapy (i.e., the patients repeatedly relive the frightening experience under controlled conditions to help him or her to think through the trauma). 8 In 80% of people with PTSD, depression or anxiety disorders, alcohol or other substance abuse occurs. 3,21 The likelihood of treatment success of peripheral nerve injuries of the upper extremities is therefore increased when these other epsychological e conditions are appropriately diagnosed and treated accordingly. ...
Background:
Psychological symptoms frequently accompany severe injuries of the upper extremities and are described to influence functional outcome. As yet, little knowledge is available about the occurrence of posttraumatic psychological stress and the predictive characteristics of peripheral nerve injuries of the upper extremity for such psychological symptoms. In this prospective study, the incidence of different aspects of early posttraumatic stress in patients with peripheral nerve injury of the forearm is studied as well as the risk factors for the occurrence of early psychological stress.
Methods:
In a prospective study design, patients with a median, ulnar or combined median-ulnar nerve injury were monitored for posttraumatic psychological stress symptoms with the Impact of Event Scale (IES) questionnaire up to 3 months postoperatively.
Results:
Psychological stress within the first month after surgery occurred in 91.8% of the population (IES mean=22.0, standard deviation (SD)=17.3). Three months postoperatively, 83.3% (IES mean=13.3, SD=14.1) experienced psychological stress. One month postoperatively 24.6% and 3 months postoperatively 13.3% of the patients had IES scores indicating for the need for psychological treatment. Female gender, adult age and combined nerve injuries were related to the occurrence of psychological stress symptoms 1 month postoperatively.
Conclusions:
In the majority of these patients, peripheral nerve injury of the forearm is accompanied by early posttraumatic psychological stress, especially in female adults who suffered from combined nerve injuries.
... Hand injury brings specific aesthetic concerns of disfigurement and acceptability by others. 9 The cosmetic acceptance varies considerably with age, sex and personality, and is strictly dependent on the patient as to how they see the hand and how they believe others see it. 1 Also, it has been reported that 49% of patients with hand injury showed sexual dysfunction (impotence, reduced sexual desire and rejection of sexual contact by the partner) the first months after injury and 19% at 6 months after the event, 10 because of the fact that the hand is connected with human contact and sexuality and therefore represents, even if subconsciously, a sexual organ. ...
... Progressive exposure to the workplace is usually useful in the treatment depending on type and severity of psychological problems (related to the type and extent of the trauma). 9 It has been shown that early return to work with the help of a psychologist prevents the onset of chronic problems such as depression and impairment of personal contacts of the patient. 7 Unfortunately, usually a great part of the customers are foreigners who work illegally, without any kind of assistance and who do not speak willingly for fear of losing the job. ...
Tocco I, Salini E, Bassetto F. International Journal of Nursing Practice 2011; 17: 275–279
Impact of hand injury on patients: Psychosocially oriented nurse care
Psychological and social post-traumatic adjustments consequent to hand injury deeply affect patients' needs. Nurses are the professional figures who, within the surgery, work more closely in terms of frequency and time with patients: a targeted nurse training must be implemented. A systematic review was conducted to assess hand-injured patients nurse care. In total, 335 articles were identified, of which 20 met inclusion criteria. Issues identified included psychological response to hand injury, social implications, nurse's recognition and assessment of psychosocial needs, appropriate intervention. The results show how important it is to train nurses who are well prepared to deal with the psychological status when caring for hand-injured patients, in order to set the most correct psychosocial assistance.
... Once this has been accomplished, we can proceed with the graduated work return that we have discussed above. While we have been successful in getting 85% of work-injured individuals back to work with the same employer following an on-site work evaluation, we have not had any individuals with this degree of fearfulness who have actually returned to work on the same machine on which they were injured (Grunert et al., 1990). It is important to note that 8% of our patients were unable to return to work due to the severity of their injuries, which included bilateral amputations, crush or nerve injuries, or the inability to tolerate a prosthesis due to phantom sensation and pain (Rosen & Grunert, 2012). ...
Work-related upper extremity injuries result in significant functional and psychological symptoms. Early psychological intervention in an interdisciplinary setting is highly effective in promoting adjustment to these injuries. Patients can simultaneously heal physically and adjust emotionally through the use of imaginal exposure, cognitive reprocessing, and behavioral desensitization. This allows for reduction of social stigma, adjustment to altered functioning, and return to a productive lifestyle. The interdisciplinary team approach fosters credibility and acceptance of psychological interventions for this population.
... [11,14,15,[31][32][33][34][35][36] Nearly 50% of work-related injuries of the upper extremities have been found to be associated with the development of PTSD. [14,37,38] In a study evaluating 67 patients with hand injuries, 44 of the patients had experienced some symptoms of PTSD, although they did not fulfill the diagnostic criteria. [39] Another study reported increased trauma-related distress symptoms in almost half of patients with self-inflicted injuries. ...
The aim of this study was to compare patients who were injured by punching glass with patients who were injured accidentally, according to demographical, clinical, and psychological parameters.
The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory (BPI), and the Beck Depression Inventory (BDI) were used for evaluating severity of the injury, functionality, impact of the injury on the patient, attention deficiency, patterns of borderline personality symptoms, and level of depression, respectively.
Patients who were injured by punching glass were significantly younger and more likely to injure their dominant hand. The severity of injury and all psychological scales were significantly higher in patients who were injured by punching glass.
Hand therapy specialists should be aware of potential problems in patients who were injured by punching glass.
... [11,14,15,[31][32][33][34][35][36] Nearly 50% of work-related injuries of the upper extremities have been found to be associated with the development of PTSD. [14,37,38] In a study evaluating 67 patients with hand injuries, 44 of the patients had experienced some symptoms of PTSD, although they did not fulfill the diagnostic criteria. [39] Another study reported increased trauma-related distress symptoms in almost half of patients with self-inflicted injuries. ...
Objective: The aim of this study was to compare patients who were injured by punching glass with patients
who were injured accidentally, according to demographical, clinical, and psychological parameters.
Methods: The Hand Injury Severity Score (HISS), the Duruöz Hand Index, the Quick Disabilities
of the Arm, Shoulder and Hand scale (Q-DASH), the Impact of Event Scale-Revised (IES-R), the
Adult Attention-Deficiency/Hyperactivity Scale (A-ADHS), the Borderline Personality Inventory
(BPI), and the Beck Depression Inventory (BDI) were used for evaluating severity of the injury, functionality,
impact of the injury on the patient, attention deficiency, patterns of borderline personality
symptoms, and level of depression, respectively.
Results: Patients who were injured by punching glass were significantly younger and more likely to
injure their dominant hand. The severity of injury and all psychological scales were significantly higher
in patients who were injured by punching glass.
Conclusion: Hand therapy specialists should be aware of potential problems in patients who were
injured by punching glass.
Keywords: Hand injury/injuries; post-traumatic; psychology; rehabilitation; stress disorder.
... Those who feel helpless and fear with anxiety, are generally the predominant post injury emotions [68]. Guilt will more frequently occurs when the injured person feels a sense of having contributed to the accident either through engaging in risky behavior or through an error that resulted in the injury [69]. From a therapy standpoint, it is important to process each of these issues in order for the patient to function in a maximally effective manner following the injury. ...
Objective: Acquired hand trauma is a significant event that often affects an individuals' life in diverse manners. The present paper aims to review the psychological issues in hand trauma along with factors that affect recovery from the same. Method: A relevant search for literature on psychological issues in hand trauma was made across search engines like Google Scholar, Medline and Pubmed and relevant studies were selected for this review. The studies include those on symptomatology, course as well as treatment. The studies were analyzed critically along with inputs of personal clinical experience of the authors. Results: Psychological symptoms that occur after hand trauma together with the treatment methods that provide relief from psychological symptoms are discussed. Symptoms of post-traumatic stress disorder (PTSD), flashbacks, concerns with personal appearance, avoidance of reminders of the trauma and physiological arousal along with sleep issues have been discussed. The article also looks at the psychosocial effects of hand trauma including marital and sexual issues that may arise. Treatment interventions commonly used in the form of imagery and in vivo exposure with and without cognitive restructuring are explained along with psycho-education approaches that may benefit these patients. Conclusions: It is important that surgeons and professionals dealing with hand trauma are aware of the psychological issues in hand trauma and to take appropriate steps to deal with any such problems that ensue.
... If these symptoms persist with the same degree of severity for more than 1 month, the clinical diagnosis is defined as PTSD. It is seen in B50% of hand-injury patients (Grunert et al., 1990(Grunert et al., , 1992Hennigar et al., 2001;Koestler, 2010). Grunert et al. (1992) suggest that although the psychological impact is at its worst in the first few months following the injury, patients may still experience some psychological problems, and have flashbacks and fear of reinjury even after 18 months. ...
To compare responsiveness Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales in patients diagnosed with osteoporosis.
A number of 70 osteoporosis patients who were in their menopause period at least for three years were enrolled in our study. The patients completed Short Form-36 (SF-36), Nottingham Health Profile (NHP), and QUALEFFO-41 scales during pretreatment period and one year after the termination of the treatment. Reponsiveness was compared between questionnaires using standardized responsiveness mean (SRM), the effect size (ES), and Guyatt's method.
All scales revealed statistically significant improvement after the treatment. Upon this finding, calculations related with responsiveness indices for SF-36 (Physical Health and Mental Health), NHP (Total point), and QUALEFFO-41 (Total point) demonstrated highly responsive. ES=1.67 and 1.55, SRM=1.55 and 1.85, Guyatt value=2.20 and 1.91 for SF-36 Physical Health and Mental Health. ES=1.35, SRM=1.35, Guyatt value=1.72 for NHP. QUALEFFO-41's ES=2.56, SRM=4.32 and Guyatt value=2.31.
Osteoporosis specific scale as QUALEFFO-41, gives more spesific information about the quality of life of osteoporotic patients. If patients with osteoporosis will be compared with other diseases regarding quality of life, then SF-36, one scale was used to evaluate general quality life of such patients, should be preferred against NHP.
... life. 18 Specifically mutilations and amputations bring severe problems of intrusion and depression. 19 Also in our cohort, patients affected by phalanx amputation reported higher GSI and DEP scores at each study point (the injury group was too small to perform a statistical analysis of significance). ...
Mutilating hand injuries are frequently associated with the development of psychic impairments such as posttraumatic stress disorder, depression, regression of the personality, and refusal of the disease. The psychic distress acts as a source of disability that outweighs the functional loss, causing impairments that may prevent a full recovery after the accident. The present study highlights the need for nurses to be familiar with the emotional response in the patients, to implement a specialized and comprehensive approach and detect stress points that may require early intervention.
... If these symptoms persist with the same degree of severity for more than 1 month, the clinical diagnosis is defined as PTSD. It is seen in B50% of hand-injury patients (Grunert et al., 1990(Grunert et al., , 1992Hennigar et al., 2001;Koestler, 2010). Grunert et al. (1992) suggest that although the psychological impact is at its worst in the first few months following the injury, patients may still experience some psychological problems, and have flashbacks and fear of reinjury even after 18 months. ...
The aim of this study was to investigate the acute-stage and later-stage impacts of trauma on a patient, and to determine the relationship between the degree of the impact of the event and recovery of hand function in patients with traumatic hand injury. The functional status of patients was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; psychological influence was assessed by the Beck Depression Inventory (BDI); and the impact of the event was assessed by the Impact of Event Scale-Revised (IES-R) both during the acute stage and at a later stage. Fifty-four patients completed the study. The DASH, BDI, and IES-R scores were significantly improved at a later stage compared with the acute stage (P<0.05). The DASH, BDI, and IES-R scores had significant positive correlations with each other in both the acute stage and later stage (P<0.05). In the linear regression analysis, the independent variables affecting the DASH score at a later stage were the DASH and IES-R scores in the acute stage (P<0.05), whereas depression scores had no effect on functional outcome (P>0.05). Our study suggests that depression status, functional status of the hand, and impact of the event improve at a later stage, and that the functional outcome at a later stage is affected by the degree of impact of the event, and the functional status of the hand in the acute stage, in patients with traumatic hand injury. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
... Future researchers also should investigate the influence of other potentially important factors not assessed in the current study, including attributions, coping strategies, and social support, ultimately leading to recommendations for facilitating improved functioning postamputation. Current clinical recommendations tend to focus on cognitive-behavioral approaches to enhance coping with amputation-related concerns (Oaksford et al., 2005;Rybarczyk et al., 2000) and to manage disruptive PTSD symptoms (Grunert et al., 1992;Grunert, Matloub, Sanger, & Yousif, 1990). Results from the current study suggest that it may also be important to examine therapeutic ways to ameliorate negative cognitive processing in the 1st months following amputation and to foster positive cognitive processing within the 1st year following amputation. ...
Objective: To describe depressive symptoms, posttraumatic stress disorder (PTSD), and posttraumatic growth at 6 and 12 months following amputation and to explore differences by demographic variables and cognitive processing of trauma. Participants: 83 adults with newly acquired limb loss. Setting: Two large metropolitan hospitals. Main Outcome Measures: The Patient Health Questionnaire depression module, PTSD Checklist, and Posttraumatic Growth Inventory. Results: Significant depressive and PTSD symptoms were reported by 15%-25% of participants. Relatively low levels of posttraumatic growth were reported. Negative cognitive processing predicted depressive and PTSD symptoms at 6 months. Positive cognitive processing predicted posttraumatic growth at 12 months. Conclusion: Cognitive processing appears to be integral to positive and negative psychosocial outcomes following amputation and should be targeted by clinical interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... In their sample of workers' compensation patients with various injuries, Burgess et al. (1996) found that the higher endorsement of PTSD symptoms was related to premature discharge from a rehabilitation facility. Studying patients with work-related hand injuries, Grunert, Matloub, Sanger, and Yousif (1990) found that the presence of flashbacks was associated with greater risk for work avoidance. Similarly, our clinical experience with workers' compensation patients indicates that the presence of PTSD phobic symptoms is often a barrier to workers returning to their workplace. ...
Objective: To determine whether individuals with traumatic upper limb amputations would report more symptoms of posttraumatic stress disorder (PTSD) and depression than individuals with traumatic lower limb amputations. Study Design: Retrospective file review. Setting: CARF-accredited outpatient rehabilitation center. Participants: Thirty workers with unilateral upper limb amputations and 25 workers with unilateral lower limb amputations. Main Outcome Measures: Presence or absence of depression, symptoms of PTSD, and pain. Results: The upper limb group had a higher frequency of depression and symptoms of PTSD than the lower limb group. The 2 groups did not differ with respect to pain complaints. Conclusion: More so than injuries to the lower limbs, upper limb injuries may render individuals vulnerable to PTSD and depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... However, the relevant literature indicates that both victims of accidents in high-risk occupations and workers injured in industrial accidents show increased levels of emotional distress, anxiety and depression , subjective personal vulnerability, anger, irritability, somatic focus, preoccupations about the future, inactivity, and dependence24252627. Indeed, workplace accidents are increasingly reported as potentially traumatic events that may result in the development of acute stress disorder, adjustment disorder, or eventually PTSD [24, 25,28293031. A percentage of injured workers as high as 30–40% has been reported to show symptoms consistent with full or partial PTSD after the accident (see [29, 31]). ...
The present descriptive study was aimed at evaluating posttraumatic and depressive symptoms and their cooccurrence, in a sample of victims of workplace accidents. Also, posttraumatic negative cognitions were assessed. Eighty-five injured workers were evaluated, using the PTSD Symptom Scale, the Beck Depression Inventory II, and the posttraumatic Cognitions Inventory. 49.4% of injured workers reported both depressive and posttraumatic symptoms of clinical relevance. 20% only reported posttraumatic, but not depressive, symptoms, and 30.6% did not report either type of symptoms. The group with both posttraumatic and depressive symptoms displayed greater symptom severity and more negative cognitions about the self and about the world than the other two groups. The obtained findings indicate that workplace accidents can have a major impact upon the mental health of victims. Early interventions should be focused not only on the prevention or reduction of posttraumatic and depressive symptoms but also on restructuring specific maladaptive trauma-related cognitions.
... Some articles are published in other languages than English: Spikowska analyses the quality of life after upper limb amputation in Polish [13], Engelhardt et al. [14] in German and Chevrier et al. [15] describe psychosocial aspects of rehabilitation in upper limb amputations in French. Other publications are case studies [16], or address satisfaction with prostheses and functional abilities [17,18] or the treatment of post-traumatic stress disorder [19]. One article discusses the team approach in dealing with the psychosocial aspects of traumatic upper limb loss [6]. ...
To assess how upper limb amputation affects mental health and life satisfaction.
Cross-sectional study comparing the mental health and perceived satisfaction with life among adult acquired major upper limb amputees in Norway with a control group drawn from the Norwegian general population. The scales used were the Satisfaction With Life Scale (SWLS) and the Hopkins Symptom Check List 25-item (SCL-25). The groups were compared using multiple linear regression analyses.
The amputees scored significantly lower on life satisfaction than the control group. A tendency to poorer mental health in the amputee group was observed, but there was no clear evidence of such a difference. The amputation effect on life satisfaction seemed to be mediated mainly by changes in occupational status and by the occurrence of short- or long-term complications related to the amputation.
Our findings imply that rehabilitation of upper limb amputees should emphasise facilitating return to work as well as the prevention of short- and long-term complications, and that this will be of importance not only for the amputees' physical function, but for the maintenance of acceptable life satisfaction. Further studies on the effect of upper limb amputation on mental health are recommended.
Plastic surgery trauma care services vary widely between hospitals in the UK. The authors evaluated their plastic surgery trauma service and illustrated the use of lean thinking to successfully implement small interventions to create positive change. The study findings demonstrated an increase in the proportion of patients with trauma being treated in the outpatient clinic rather than in the main theatres. This coincided with an increase in the proportion of patients being treated on the day of presentation to hospital.
Symptoms are determined in large part by mindsets. Feelings of distress and unhelpful thoughts (misinterpretations) of symptoms account for much of the variability in comfort and capability with the severity of the underlying pathophysiology making a more limited contribution. Incorporating this experimental evidence into the daily practice of hand surgery will help us find ways to develop healthy mindsets, to prioritize the alleviation of distress and the gentle redirection of unhelpful thoughts, to avoid unnecessary surgery, and to provide better psychological and social support for people recovering from injury and surgery.
Introduction
Impaired functioning is seen in patients following replantation surgery to the thumb or fingers. Our aim was to explore long-term consequences and adaptation in daily life after a thumb and/or multiple finger amputation followed by replantation surgery during young age.
Methods
Semi-structured interviews were conducted with nine recruited individuals and analysed using content analysis. The participants were asked to describe their hand function, pain, appearance, emotional consequences, impact on daily life and strategies for overcoming daily challenges.
Results
The interviews revealed five main categories: memories of the injury and concerns for the future; hand function, pain and cold sensitivity; feelings about having a visibly different hand; adaptation to impairments and challenges in daily life; and key messages to healthcare professions and advice to future patients. The circumstances of the injury were well remembered. Pain at rest was rare but occurred when grasping. Cold sensitivity was a major issue. Appearance-related concerns varied from none to a major problem. Despite impaired hand function, solutions were found to challenges in daily life. Compensatory strategies, personal resources and support from others were important in this adaptation process.
Conclusions
Patients with replantation surgery after an amputation during young age adapt to challenges in daily life over time. Healthcare professionals should offer adequate support to enable emotional processing of trauma experience. Appearance-related concerns should be addressed to prevent distress. Information about alleviating strategies to overcome long-term problems with cold sensitivity should be emphasized.
Study design
Prospective cohort study
Background
Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem.
Purpose
of the study: This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs.
Methods
Two hundred and twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 hours a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multi-dimensional adherence model (MAM) including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. Modified Hand Injury Severity Scale (MHISS) was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). A multivariate logistic regression model was constructed for orthosis adherence.
Results
One hundred and thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis while 67 (50.4%) was partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [OR=1.2 (95%CI=1.1-1.3), p=0.001] and partial adherence [OR=1.1 (95%CI=1.0-1.2), p=0.01].
Conclusions
Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence.
Objective: To study the diagnostic yield of FNAC when compared with histopathology and to determine the
pathological spectrum of head and neck lesions in our region.
Study Design: Cross-sectional study
Place and Duration of study: This study was conducted at the Department of Pathology, Frontier Medical &
Dental College, Abbottabad from January 2016 to April 2017,
Materials and Methods: A total of 150 patients with superficial and palpable head & neck swelling underwent fine
needle aspiration and cytology using standard protocol.
Results: Out of 150 patients, there were 84 males and 66 females with male to female ratio of 1.27:1. Mean age was
35±17.42 years. Most of the patients, 77.33%, were between the ages of 21-60 years. As per the site of involvement,
most of the lesions, 40%, occurred in lymph nodes followed by salivary glands, 30% cases, and cystic, soft and
other tissues, 30% cases. The most common benign lesion involving lymph nodes was tuberculosis while most
common malignant lesion involving lymph nodes was metastatic deposits to lymph nodes. In case of salivary
glands, the most common benign lesion was pleomorphic adenoma while most common malignant lesion was
mucoepidermoid carcinoma. Among benign lesions, lipoma was observed in majority of cases involving cystic, soft
and other tissues while among malignant lesions, metastatic squamous cell carcinoma was most common. When
compared to histopathology, the overall sensitivity and specificity of FNAC was 73% and 93% in the diagnosis of
head and neck lesions. In case of salivary gland lesions, sensitivity and specificity of FNAC was 65% and 89%
while it was 72% and 95% in case of lymph node lesions and 84% and 100% respectively in case of cystic, soft
tissue and other tissue lesions.
Conclusion: Head and neck region encompasses a diversified range of diseases ranging from inflammatory to
malignant ones. Accurate diagnosis of these lesions is very important for their successful treatment. FNAC is a safe,
reliable, convenient and minimally invasive procedure which can be done on out-patient basis. It provides accurate
information in most cases which in turn helps in making treatment decisions as it ascertains the type of lesion.
Key Words: Salivary gland, Head and neck, FNAC
Objective:
We developed easily accessible imagery-based treatment program for patients with post-traumatic stress disorder (PTSD) related to workplace accidents and investigated the effects of the program on various PTSD related symptoms.
Methods:
The program was based on an online platform and consisted of eight 15-min sessions that included script-guided imagery and supportive music. Thirty-five patients with workplace-related PTSD participated in this program 4 days per week for 4 weeks. Its effects were examined using self-report questionnaires before and after the take-home online treatment sessions.
Results:
After completing the 4-week treatment program, patients showed significant improvements in depressed mood (t=3.642, p=0.001) based on the Patient Health Questionnaire-9 (PHQ-9), anxiety (t=3.198, p=0.003) based on the Generalized Anxiety Disorder seven-item (GAD-7) scale, and PTSD symptoms (t=5.363, p<0.001) based on the Posttraumatic Stress Disorder Check List (PCL). In particular, patients with adverse childhood experiences exhibited a greater degree of relief related to anxiety and PTSD symptoms than those without adverse childhood experiences.
Conclusion:
The present results demonstrated that the relatively short online imagery-based treatment program developed for this study had beneficial effects for patients with workplace-related PTSD.
Purpose:
There is a high incidence of posttraumatic stress disorder (PTSD), depression, suicide risk, and psychological distress after orthopedic trauma and hand and upper-extremity injury. Although patients with traumatic adult brachial plexus injury are particularly vulnerable to psychologic distress, minimal clinical data exist about this cohort of patients. In this study, we sought to discover the prevalence of depression, PTSD, suicidal ideation, and substance abuse.
Methods:
Between February, 2013 and July, 2014, during scheduled preoperative and/or postoperative appointments, the social worker at a metropolitan brachial plexus center conducted psychosocial assessments and questionnaire assessments of 21 patients evaluating for PTSD, depression, and substance use using 3 validated scales: PTSD Checklist-Specific, Patient Health Questionnaire-8, and National Institute on Drug Abuse Quick Screen.
Results:
Brachial plexus injury strongly affected self-reported psychological well-being; 7 of 21 (33.3%) divulged suicidal ideation. Diagnosticand Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnosis was supported by PTSD Checklist-Specific and Patient Health Questionnaire-8 results: 4 of 21 (19.0%) met criteria for PTSD and 4 of 21 (19.0%) exhibited clinical depression. Patients reported no changes in social alcohol and tobacco use or substance abuse.
Conclusions:
Brachial plexus injury significantly influences psychological well-being and daily functioning. As a result, patients experience a high prevalence of PTSD, depression, and suicidal ideation. Patients with brachial plexus injury have a high prevalence of psychological concerns and challenges that require continued attention throughout treatment.
Type of study/level of evidence:
Prognostic IV.
Objective:
The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation.
Methods:
Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20-65 years) were evaluated at the end of a mean follow-up time of 36 months (19-50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed.
Results:
The mean score for the DASH questionnaire was 6.6 (range: 0-39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05).
Conclusion:
Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up.
Level of evidence:
Level IV, therapeutic study.
Objective: To assess time management skills with respect to effect on academic performance of medical students. Study Design: Descriptive / cross-sectional study Place and Duration of Study: This study was at the Department of Medical Education, Dow University of Health Sciences, Karachi from 1st January 2015 to 31st December 2015. Materials and Methods: The sample of the study consists of 652 medical college students. Academic performance has been checked by student affairs and examination department of college. Results: The relationship between medical students' time management scores and academic performance ratings is measured. A positive and significant relationship was discovered between time management score and performance rating (r= 0.584, p= <0.001). Correlation is significant at the 0.01 level (2-tailed). Male students have better time management scores. Conclusion: This research work underlines the crucial need of understanding the part of "time management in academic performance.
Background:
Research demonstrates that hand injuries may cause psychological difficulties. To enhance recovery, therapists must provide appropriate referrals. The purpose of this study was to explore the use of psychosocial services by occupational therapists (OTs) and certified hand therapists (CHTs) post hand and upper limb injury or trauma.
Methods:
A quantitative survey design was implemented using a self-made questionnaire, which consisted of questions regarding demographic information, types and frequency of hand and upper limb injuries, psychiatric diagnoses, frequency of psychosocial service referrals, frames of references used, types of psychosocial assessments and interventions employed, and barriers to psychosocial services. The questionnaire was randomly distributed to 29 therapists.
Results:
The most frequently recorded frame of reference was the Biomechanical. Only 17.2% participants implemented psychosocial assessments. Sixteen of the 29 participants referred to 9 possible psychosocial services; however, majority of referrals were "occasionally." OTs specialized in mental health, behavioral specialists, and social workers were recorded with the least amount of referrals. A Spearman rank correlation found a weak, but significant inverse relationship between referrals by therapists and years of experience as an OT or CHT (-0.322 and -0.351, P < .05, respectively).
Conclusions:
Therapists appear to be biomechanically oriented which may impact outcomes. An inverse correlation was found where the less experience participants had, the more likely they were to refer to psychosocial services. The results emphasized the lack of psychosocial assessments, interventions, and referral services being used by therapists. Further education to therapists, third parties, and other health professionals is warranted.
Die Entlastung der Hände von der Funktion der Fortbewegung geht evolutionsgeschichtlich mit einer Zunahme des aufrechten Ganges und einer Differenzierung der Hand zu einem Greif-, Halte- und Wurforgan einher. Das Gehirn veränderte seine Größe und Struktur, wahrscheinlich um sich auf die räumlich komplexere und körperlich gefährlichere Lebenswelt einstellen zu können (Huber 2006).
Aim: To develop an experimental rat model of post-traumatic stress disorder (PTSD) so as to detect its behavior and function of learning and memory. Methods: The rat model of PTSD was made by means of imprisonment and electric shock. The total behavior level of PTSD rats and the composition of motor types were, detected within the previous 25 minutes. The function of learning and memory was detected by shuttle box test. Results: The total behavior level of PTSD rats presented polarization, which decreased in the most of rats (7/9) and increased in a few (2/9). There was a significant difference between the PTSD rats and normal rats (t=10.230, P <0.01). Within the previous 25 minutes, the percentage of stillness and escaping was increased to (11.08 ± 1.67)% for the control group and (24.24 ± 9.69)% for the MD group (t= -6.878, P < 0.05), the percentage of grooming was significantly decreased to (28.34 ± 6.86)% and (13.13 ± 7.02)% for the two groups respectively (t=2.234. P <0.05). In the test of learning and memory function, active response to avoidance significantly decreased (P < 0.01), and failed response to avoidance significantly increased (P < 0.01). Conclusion: The PTSD rat model produced by imprisonment and electric shock has remarkable abnormal behavior and impairment of learning and memory. It is similar to the clinical symptoms.
Work-related traumatic amputation is often associated with clinically significant psychological sequelae, and can present a number of unique rehabilitation and vocational challenges. In this paper, we review the major psychological factors in work-related amputation by focusing on anxiety reactions including posttraumatic stress disorder, depression, grief, body image disturbances, and chronic pain. Suggestions for rehabilitation counselors are discussed and we describe how cognitive behavioral strategies can be used to address the psychological aspects of work-related amputation. Future research directions are also suggested.
Traumatic upper extremity amputation is a life-altering event, and recovery of function depends on proper surgical management and postoperative rehabilitation. Many injuries require revision amputation and postoperative prosthesis fitting. Care should be taken to preserve maximal length of the limb and motion of the remaining joints. Skin grafting or free tissue transfer may be necessary for coverage to allow preservation of length. Early prosthetic fitting within 30 days of surgery should be performed so the amputee can start rehabilitation while the wound is healing and the stump is maturing. Multidisciplinary care is essential for the overall care of the patient following a traumatic amputation of the upper limb.
Post-traumatic psychiatric reactions to physical trauma are readily acknowledged and accepted. However, there is a relatively new phenomenon of developing similar reactions after providing emergency care to such patients. The purpose of this study was to examine the effectiveness of a crisis intervention technique known as group psychological debriefing, which is designed to mitigate the impact of post-traumatic morbidity in individuals exposed to vicarious traumatization. Using adequately controlled, peer-reviewed journal articles and clinical proceedings as the database, 698 subjects from 10 investigations were submitted to a meta-analysis. The results support the effectiveness of group psychological debriefings in alleviating the effects of vicarious psychological distress in emergency care providers. Copyright © 1999 John Wiley & Sons, Ltd.
Because attitudes signify how an individual organizes and integrates perceptions of self and social context, effects of a man-made disaster in the workplace on attitudes toward self, family, workplace, community, and social issues were surveyed in school personnel 6 and 18 months after a shooting and intervention to extend understanding of human response to stress. Results showed that attitudes were more positive than negative in this study group. Additionally, specific attitudes were associated with specific preexisting personality and familial variables, as well as posttraumatic and associated symptoms. Positive attitudes toward the self were associated with fewer maladaptive personality and family characteristics. Positive attitudes toward family correlated with fewer maladaptive personality features and fewer posttraumatic symptoms. Positive attitudes toward community and workplace, especially coworkers, were associated with fewer posttraumatic stress disorder (PTSD) and associated symptoms. Generally, the findings suggest that a variety of attitudes and their evolution in the wake of a disaster, some of which may be quite specific to the event, are associated with posttraumatic morbidity, subject variables, and with other attitudes. The authors discuss implications of these findings within the biopsychosocial framework of malignant memories.
Prolonged exposure (PE) is a widely promulgated treatment modality for PTSD. While successful with many subjects, PE also has a significant failure rate (i.e., dropouts, nonimprovement, symptom exacerbation). To date, outcome research has not examined why PE at times appears to be the treatment of choice for PTSD and why it sometimes needs to be combined with cognitive restructuring interventions to be effective. This study presents a detailed cognitive-behavioral analysis of two industrial victims suffering from PTSD who failed to benefit from PE alone, but who subsequently made a quick and lasting recovery when an imagery-based, cognitive restructuring component was added to their exposure treatment. A comparative analysis is presented of the theoretical underpinnings and treatment components of the behavioral and cognitive treatments used with the subjects in this study—PE and imagery rescripting and reprocessing therapy (IRRT). PE is a behavioral treatment based upon theories of classical conditioning that relies on exposure, habituation, desensitization, and extinction to facilitate emotional processing of fear. By contrast, IRRT is cognitive therapy applied in the context of imagery modification. In IRRT, exposure is employed not for habituation, but for activating the trauma memory so that the distressing cognitions (i.e., the trauma-related images and beliefs) can be identified, challenged, modified, and processed.
Con ocasión de nuestra colaboración con la Unidad de Cirugía de la Mano (HCUG), nos ha correspondido hacernos cargo de pacientes traumatizados quienes presentaban lesiones entre ligeras y graves del miembro superior. Nos llamó la atención los pacientes que présentaban amputaciones. Constatamos que las intervenciones psiquiátricas tardías son en general mal aceptadas por los pacientes y que estas no permitían ayudar a estas personas. A partir de estas constataciones, hemos elaborado una nueva estrategia de intervención en colaboración con nuestros colegas cirujanos. Hemos sido informados de los pacientes gravemente traumatizados a nivel del miembro superior siendo evaluados desde el comienzo de la hospitalización. Esto presenta tres grandes ventajas. Primero, los pacientes aceptan más facilmente la ayuda sabiendo que estaran confrontados a momentos dificiles desde el punto de vista psicológico; segundo, podemos ayudarlos hablándoles de sus temores con referencia al futuro y así verbalizar sus angustias para ayudarlos a afrontar lo más eficazmente posible el futuro; tercero, jugamos un rol en la comunicación entre el equipo quirúrgico, el equipo de enfermería y el paciente. Pensamos que este tipo de intervención mejora las condiciones de hospitalización y debería a largo plazo disminuir los riesgo de evolución psíquica negativa.
Severe, work-related hand injuries are often accompanied by a significant number of psychological symptoms that are frequently associated with posttraumatic stress disorders. These symptoms occur in the following four domains of psychological functioning: cognitive, affective, physiological, and behavioral. This study examined the incidence of a variety of symptoms occurring with work-injured patients. Interviews were conducted at 1 week, 3 months, 6 months, 12 months, and 18 months after injury. Symptom frequencies were recorded. The results indicate that many of these symptoms were persistent 18 months later and continued to be significantly debilitating. The results support the need for psychological intervention after severe, work-related hand injuries.
The consequences following work-related injuries are far reaching, which are in part due to unrecognized and untreated posttraumatic stress disorder (PTSD). Imaginal exposure is a frequently used cognitive behavioral approach for the treatment of PTSD. This study examined the impact of early versus delayed treatment with imaginal exposure on amelioration of PTSD symptomatology in individuals who suffered upper extremity injuries.
Sixty individuals who suffered severe work-related injuries received standard, non-randomly assigned psychological treatment for PTSD (e.g., prolonged imaginal exposure) either early (30-60 days) or delayed (greater than 120 days) following severe work-related upper extremity injury. Nine measures of various components of PTSD symptomatology were administered at onset of treatment, end of treatment, and at 6-month follow-up evaluations.
Patients showed significant treatment outcomes at all three measurement intervals in both the early and delayed groups demonstrating that Prolonged Imaginal Exposure is an appropriate treatment for persons diagnosed with PTSD. In addition, there was no difference in return to work status between the early and the delayed treatment groups. However, the early treatment group required significantly fewer treatment sessions than the delayed treatment group.
Results supported the utility of imaginal exposure and the need for early assessment and referral for those diagnosed with PTSD following upper extremity injuries.
Mental disorders are common in our industrialised society and inevitably affect the working population. Over the last few years greater attention has been focussed on work-related psychopathologies due to an increasing number of studies regarding workplace bullying.
This study reports our observations on patients with mental disorders who came to our Occupational Health Centre because they perceived themselves to be victims of negative working conditions. An indepth analysis of their working conditions led us to the conclusion that many of these disorders were to be attributed to the workplace.
Between 2004 and 2010, 449 workers attended our Occupational Health Centre, most suffering from mental disorders which they ascribed to negative working conditions. All patients had an initial consultation session with an occupational physician which focused on the environmental and relational characteristics of their place of work. Thereafter, patients underwent a second clinical evaluation with a psychologist including several psychological tests. At the end of diagnostic process, the occupational physician and the clinical psychologist drew their clinical conclusions and defined the possible relationship with the working condition.
For 379 out of 449 patients/workers, a positive and causal relationship between medical disorders and working conditions was established. The mental disorders observed in these groups of workers were: mixed anxiety and depressive disorder (53.6%), depressive disorder (16.2%), adaptation disorder (15.9%), anxiety disorder (13%) and only 1.3% post-traumatic stress disorder. The working conditions favouring the mental disorders were: workplace bullying, such as person-related bullying (30.1%) and task-related bullying (14.8%), adverse situations causing work distress (38.2%) or non-specific work discomfort (16,9%).
Our experience showed that not only workplace bullying can cause different psychiatric disorders but also adverse situations that favour work distress and non-specific work discomfort often give raise to the same disorders. Negative working conditions can play a significant role in the development of psychological-psychiatric disorders: such disorders related to occupational conditions are on the increase in many industrialised countries.
Work impairment and disability are common consequences of posttraumatic stress disorder (PTSD), as reflected by significant
rates of sickness absence, failure to return to work, and reduced work performance. Within the psychological injury field,
the issue of work impairment and disability in PTSD often arises in workers’ compensation and disability insurance claims
and in personal injury litigation. In this context, clinical and forensic practitioners are faced with challenges in rendering
expert opinions on diagnosis, causality, prognosis, and recommendations for treatment and rehabilitation. To promote understanding
of this important, yet understudied area, there are three aims of this paper: first, to review the current literature on work
impairment and disability associated with PTSD; second, to draw on this literature to present a biopsychosocial framework
of work impairment and disability in PTSD; and third, to offer suggestions for improving the assessment and management of
PTSD-related work impairment and disability.
KeywordsPosttraumatic stress disorder-Functional impairment-Disability-Occupational functioning-Work impairment
Posttraumatic stress disorder (PTSD) is a psychological consequence of traumatic work-related hand injury. In the current study, we investigated this relationship by examining the prevalence, of PTSD symptoms in 121 Worker's Compensation patients enrolled in a work rehabilitation program following a wide array of work-related injuries. Eighty-eight men and 33 women, ranging in age from 16 to 78 (M=40.9,SD=10.2), completed the Injury Adjustment Survey, a measure of PTSD symptoms, psychological/behavioral changes following injury, and desire for psychological treatment. We found that the majority of patients reported difficulties sleeping, a diminished sense of future, loss of interest, and increased anger. Twenty percent of patients endorsed symptoms from criteria B (reexperiencing the trauma), C (persistent avoidance or numbing), and D (inreased arousal) for PTSD according to the DSM-IV. PTSD symptoms did not significantly, relate to age, gender, locations of injury, type of injury, seeing the injury occur, or length of time since injury. PTSD symptoms did significantly relate to psychological/behavioral changes or difficulties and the desire to seek psychological treatment. Discussion of the results proceeds from within a psychotraumatological framework. In general, our research confirmed that PTSD symptoms appear to be a clinically significant problem for patients suffering from a variety of work-related injuries.
Difficulties in adjustment frequently accompany severe hand injuries. The purpose of this study was to determine whether presurgical screening could predict long-term adjustment problems. One hundred thirteen patients with severe hand injuries completed a presurgical questionnaire evaluating flashbacks, avoidance, and causal factors pertaining to the injury. Patients were evaluated by a psychologist within 5 days after surgery and again 6 months later. Flashbacks initially occurred with equal frequency in occupationally and nonoccupationally injured groups. At 6-month follow-up 50% of the occupationally injured patients and 25% of the nonoccupationally injured patients had flashbacks. Avoidance of the activity at which patients were injured was also assessed. Among occupationally injured patients, 52% initially reported no avoidance compared with 17% at follow-up. Patients with nonoccupational injuries showed more initial avoidance (68%), with slightly less at follow-up (61%). Of the occupationally injured patients, 46% initially reported personal error or fatigue as the cause of their injury, but only 6% reported this as the cause at follow-up; it is interesting that at 6-month follow-up 81% of this group reported machine failure or lack of safeguards. Among nonoccupationally injured patients, 71% reported personal error as the cause of injury presurgically and 66% at 6-month follow-up. Presurgical screening appears to be a valid means of identifying persons at risk of ongoing adjustment problems after hand injury. A screening interview can easily be conducted in less than 5 minutes.
Several studies have shown that upper extremity trauma has serious, acute psychological effects after injury. This study's goal was to assess the psychological outcomes, including symptoms of major depression, posttraumatic stress disorder (PTSD), and other psychosocial variables, as well as the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) results, after severe hand trauma. We hypothesized that hand trauma would have persistent psychological sequelae long after the physical injury.
We performed a cross-sectional survey of 34 patients who had emergency hand surgery at a Level 1 trauma center an average of 16 months (range, 7-32 mo) earlier. The hand disability measure was the QuickDASH, and the psychological measures included the Center for Epidemiologic Studies Depression Scale, the Screen for Posttraumatic Stress Symptoms, the Medical Outcomes Study Social Support Survey Form, the Social Constraints Survey (to assess interpersonal stressors), and the Perceived Stress Scale.
The overall QuickDASH score was 27. The mean score for PTSD was 13 (above the clinical threshold for PTSD), and 29% of respondents had high levels of both depression and PTSD. High pain scores on the QuickDASH were strongly correlated with both depression and PTSD symptoms.
This study found high levels of psychological distress in patients after hand trauma. Hand disability was strongly related to pain, depression, and PTSD symptoms. This study shows that the psychological sequelae of hand trauma can persist long after the physical injury.
Therapeutic IV.
NARRATIVE REVIEW: Pain is considered a fundamental ramification of hand injury and has been identified as one of the most acutely stressful aspects of traumatic injuries and their treatment. Both comorbid psychiatric conditions and psychosocial factors have been shown to affect medical treatment outcome in patients with hand disorders and pain, further complicating recovery and potentially leading to significant psychological, social, and economic consequences for the individual. The purpose of this article was to assist hand therapists in developing a greater understanding of psychological constructs, psychosocial variables, and comorbid psychiatric conditions and thereby facilitate the more effective identification of such factors. A case study is included to illustrate these concepts. Circumstances in which referral for a comprehensive psychological evaluation is necessary are discussed. Many of the principles reviewed are also applicable to other upper extremity and musculoskeletal conditions.
Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries.
A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?"
The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects".
It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.
Severe psychological symptoms after severe work-related hand injury, manifested as posttraumatic stress disorder, are not significantly potentiated or sustained by concomitant litigation if the patient has had early psychologic intervention. This study does not support assumptions about "accident neurosis" that delays recovery from the psychological sequelae of severe work-related hand injury.
The benefits and rationale for including a psychologic assessment of a patient with an industrial hand injury are discussed. Issues of compliance and malingering in patients are addressed. The role of pre-existing conditions in understanding an injured patient's current emotional state is explored and contrasted with posttraumatic stress disorders. Recent trends in psychologic assessment techniques are highlighted.
Defines posttraumatic stress disorder (PSD), which has been used to circumscribe the varied symptoms reported by combatants, and briefly presents a conditioning model for the development of PSD. The model explains PSD as a combination of high-order conditioning and stimulus generalization. The benchmark symptoms for a diagnosis of PSD are (1) intrusive thoughts regarding the traumatic event, (2) vivid recollections of the traumatic event wherein the individual reports that he/she feels that the trauma is actually reoccurring, and (3) terrifying nightmares that contain specific details of the event. A previous study by the authors (unpublished) is reported in which several symptoms were assessed by evaluating Ss' performance on cognitive and behavioral tasks and by questionnaires selected for their relationship to specific symptoms to the disorder. Responses of PSD veterans on these tasks were compared to those of well-adjusted Vietnam combat veterans without PSD. Results show that performance on 5 of the 6 tasks was effective in distinguishing Vietnam veterans with PSD from those who were well adjusted: PSD Ss demonstrated increased physiological arousal; motoric agitation; intrusive, combat-related cognitions when exposed to cues resembling the original traumatic event; poor concentration; and poor performance on emotion identification. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.
Survivors of car crashes often suffer from a post-traumatic fear of driving, generalized anxiety and depression. Unremitting pains are also common. As part of a pilot study 30 referred subjects were exposed to imagery of driving and accidents. Seventy-seven percent were phobic of driving. Fifty-three percent responded with increased anxiety to the imagery. Twelve treatment referrals received exposure therapy and six improved markedly. An additional four improved when a Benzodiazepine was added temporarily. Four out of eight subjects lost their unremitting pains along with their fears. When guided imagery evoked intense anxiety this seemed to predict a favourable outcome. A resumption of pleasure trips was a reliable criterion of recovery. The frequency of phobic symptomatology and it's importance to the understanding and management of post-traumatic anxiety states is discussed.
Reviews the empirical literature on behavioral approaches to the treatment of posttraumatic stress disorder (PTSD). Much of the behaviorally-oriented PTSD research focuses on the treatment of combat survivors and sexual assault victims, although treatment of PTSD related to other traumas (such as transportation accidents) has been researched. Very recent research addresses the etiology and effects of PTSD in children. There is a need for controlled and comparative outcome research in light of the fact that treatment approaches to PTSD have been proven efficacious in the absence of a clear understanding of the therapeutic mechanisms that account for their positive outcome. The increase in sophistication of PTSD treatment outcome research may produce data relevant to the validation of the theoretical models of etiology and maintenance of this disorder as well as the anxiety disorders in general. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
After noting the fundamental differences between the agenda of ordinary psychotherapy and the treatment of post-traumatic stress disorder (PTSD), the paper discusses the concept of trauma vis--vis PTSD using Yalom''s (1981) four existential themes of death, freedom, isolation, and meaninglessness as organizing principles. The middle section of the paper focuses on the role of dissociation in the symptomatology of PTSD, suggesting, among other things, that many PTSD symptoms are dissociative in nature; that it is a defense against both memories of the event and the experience itself. Research is reviewed supporting the connection between PTSD and hypnotizability and the use of hypnosis in treating traumatic stress is discussed followed by two case examples. The latter section focuses on the limitations of hypnosis, transference considerations, and ends with a summary of the author''s eight C''s treatment approach: confront, condensation, confession, consolation, consciousness, concentration, control, and congruence.
This study examined on-site work evaluations as an environmental exposure strategy to promote return to work in 15 recalcitrant patients who had failed to benefit from established methods of reducing post-traumatic stress disorder symptoms. Following the on-site work evaluation, 87% of these patients were able to use visualisation of the work setting to further desensitize themselves and returned to work within the next eight weeks. All 87% have continued to be employed at six and twelve month follow-ups. This approach holds promise for assisting patients with hand injuries who develop post-traumatic stress disorder and fail to respond to traditional psychological strategies.
Flashbacks of a traumatic hand injury may compromise a patient's rehabilitation process. This study examined the nature and significance of these flashbacks in a work-injured population. We also evaluated the ability of these patients to return to work at the site of the original injury. Sixty-one patients with work-related, traumatic hand injuries received psychological evaluation and treatment. All patients experienced flashbacks. The following three types of flashbacks were identified: (1) a replaying of the events occurring just before the accident and continuing until the injury (replay flashbacks), (2) an image of the injured hand just after the trauma occurred (appraisal flashbacks), and (3) images in which an injury that was more severe than the one that actually occurred were perceived (projected flashbacks). Regardless of the result of injury, patients with replay flashbacks were the most likely to return to their former employment (95.2%) after only 4.8 1-hour sessions of psychotherapy for control of symptoms. Patients with a combination of appraisal and projected flashbacks were the least likely to return to work (10.3%), despite the fact they received an average of 13.1 1-hour sessions of psychotherapy.
We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%). Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.
The purpose of this study was to examine the frequency and nature of sexual dysfunction present in a population with traumatic hand injuries. One hundred twenty patients were seen for psychological evaluation during the first two months postinjury. Forty-nine percent (59) reported sexual dysfunction during the initial two months. Six months postinjury 19% (23) continued to have sexual dysfunction. At that time a more extensive sexual history was obtained. Three categories of sexual dysfunction were identified following interviews: (1) impotence (35% or 8 patients), (2) reduced sexual desire (65% or 15), and (3) rejection of sexual contact by the partner (39% or 9). Four major causes of impaired sexual functioning were reported: (1) pain (22% or 5 patients), (2) deformity anxiety (52% or 12), (3) replant anxiety (9% or 2), and (4) contagious anxiety (39% or 9). The results of this study indicate that persistent sexual dysfunction may be a major difficulty following hand trauma. The type of dysfunction as well as the perceived cause of dysfunction are not the same for each case. Consideration of each is necessary to design efficacious intervention strategies.
A review of theories of traumatic neurosis or posttraumatic stress disorder reveals a relative neglect of the role of posttraumatic imagery. The broad range of imagery has not been recognized, nor its role in the disorder adequately formulated. A two-dimensional framework for understanding posttraumatic stress disorder based on 1) repetitions of trauma-related images, affects, somatic states, and actions and 2) defensive functioning puts into perspective the centrality of traumatic imagery, implies a reorganization of DSM-III criteria, points to new directions for research, and clarifies diagnostic and clinical confusion.
A behavioral for-mulation of posttraumatic stress disorder in Vietnam vet-erans
- Keane Tm
- Zimering Rt
- Jm
Keane TM, Zimering RT, Caddell JM. A behavioral for-mulation of posttraumatic stress disorder in Vietnam vet-erans. Behav Ther 1985;8:9-12.
Graded work exposure: a psychological strategy to promote return to work following hand trauma. Presented at the seventeenth annual meeting of the American Association of Hand Surgery
- Grunert Bk
- Devine
- Ca
- Cj Smith
- Matloub Hs
- Sanger Jr
- Yousif
- Nj
Grunert BK, Devine CA, Smith CJ, Matloub HS, Sanger JR, Yousif NJ. Graded work exposure: a psychological strategy to promote return to work following hand trauma. Presented at the seventeenth annual meeting of the American Association of Hand Surgery, November 1987, San Juan, Puerto Rico. 6. 7. 8. 9.
Graded work exposure: a psychological strategy to promote return to work following hand trauma.
- Grunert BK
- Devine CA
- Smith CJ
- Matloub HS
- Sanger JR
- Yousif NJ
Graded work exposure: a psychological strategy to promote return to work following hand trauma
- Grunert
Sexual dysfunction following traumatic hand injury
- Grunert