Contribution of Kinesophobia and Catastrophic Thinking to Upper-Extremity-Specific Disability

Department of Orthopaedic Surgery, MGH Orthopaedic Hand & Upper Extremity Service, Massachusetts General Hospital, Yawkey Center 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D.C. Ring: .
The Journal of Bone and Joint Surgery (Impact Factor: 4.31). 01/2013; 95(1):76-81. DOI: 10.2106/JBJS.L.00064
Source: PubMed

ABSTRACT Upper-extremity-specific disability correlates with mood and coping strategies. The aim of this study was to determine if two psychological factors, kinesiophobia (fear of movement) and perceived partner support, contribute significantly to variation in upper-extremity-specific disability in a model that included factors known to contribute to variation such as depression, pain anxiety, and catastrophic thinking.
We performed an observational cross-sectional study of 319 patients who each had one of the following conditions: trigger finger (n = 94), carpal tunnel syndrome (n = 29), trapeziometacarpal arthrosis (n = 33), Dupuytren contracture (n = 31), de Quervain syndrome (n = 28), wrist ganglion cyst (n = 32), lateral epicondylosis (n = 41), and a fracture of the distal part of the radius treated nonoperatively six weeks previously (n = 31). Each patient completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and questionnaires measuring symptoms of depression, pain anxiety, catastrophic thinking, kinesiophobia, and perceived level of support from a partner or significant other. Stepwise multiple linear regression was used to determine significant independent predictors of the DASH score.
Men had significantly lower (better) DASH scores than women (21 versus 31; p < 0.01). DASH scores also differed significantly by diagnosis (p < 0.01), marital status (p = 0.047), and employment status (p < 0.01). The DASH score correlated significantly with depressive symptoms (p < 0.01), catastrophic thinking (p < 0.01), kinesiophobia (p < 0.01), and pain anxiety (p < 0.01) but not with perceived partner support. The best multivariable model of factors associated with greater arm-specific disability (according to the DASH score) included sex, diagnosis, employment status, catastrophic thinking, and kinesiophobia and accounted for 55% of the variation.
In this sample, kinesiophobia and catastrophic thinking were the most important predictors of upper-extremity-specific disability in a model that accounted for symptoms of depression, anxiety, and pathophysiology (diagnosis) and explained more than half of the variation in disability. Perceived partner support was not a significant factor. The consistent and predominant role of several modifiable psychological factors in disability suggests that patients may benefit from a multidisciplinary approach that optimizes mindset and coping strategies.

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    ABSTRACT: Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully.
    01/2014; 2014:803047. DOI:10.1155/2014/803047
  • Journal of orthopaedic trauma 04/2015; 29(4):200-201. DOI:10.1097/ · 1.54 Impact Factor
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    ABSTRACT: Background Some Internet sites have programs that attempt to help patients find their diagnosis based on symptoms. This study tested the null hypothesis that there are no factors associated with correspondence between online diagnosis and the hand surgeon’s diagnosis in an outpatient hand and upper extremity surgeons’ office. Methods Eighty-six outpatients were prospectively enrolled and used WebMD® symptom checker to guess their diagnosis. We collected demographic information, hours spent on the Internet per week, and the following questionnaires: Pain Catastrophizing Scale (PCS) and Center of Epidemiologic Studies Depression scale (C-ESD). Results Thirty-three percent of online diagnoses matched the final diagnosis of the hand surgeon. Factors associated with an online diagnosis corresponding to the hand surgeon’s diagnosis included sex (women) and patients who studied their symptoms online prior to the visit. The best multivariable model included sex, more years of education, and prior use of the Internet to research their medical condition and explained 15 % of the variation in correspondence of diagnosis. Conclusions The majority of online diagnoses for hand and upper extremity conditions do not correspond with the diagnosis of the treating hand surgeon. Psychological factors do not influence the correspondence of online diagnosis with the hand surgeon’s diagnosis. Level of Evidence: Prognostic, level II
    Hand 12/2014; DOI:10.1007/s11552-014-9707-x


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