How Is the Probability of Reporting Various Levels of Pain 12 Months After Noncatastrophic Injuries Associated with the Level of Peritraumatic Distress?

BACKGROUND: Psychological factors have been shown to be consistent predictors of chronic pain in people with musculoskeletal injuries. However, few prognostic studies have considered multiple risk factors including peritraumatic distress. In addition, previous research has not considered that the associations between peritraumatic distress and pain levels can vary across pain outcomes. QUESTION/PURPOSE: To determine whether an easily measurable level of baseline distress is associated with pain levels 1 year after noncatastrophic traumatic injuries when the outcome to be assessed is not normally distributed. METHODS: This was a prospective cohort study. The data were captured from two cohorts in London, Ontario, Canada, and Chicago, IL, USA. Participants were adults with acute noncatastrophic (that is, not treated with surgery or hospitalization) musculoskeletal injuries of any etiology with various injury locations (60% [145 of 241] spinal and 40% [96 of 241] peripheral) that presented to local urgent care centers. Other inclusion criteria included English/French speakers and having no other disorder that would affect their pain levels. In total, between the years 2015 and 2018, 241 participants were recruited based on the inclusion criteria. Ninety-three percent (225 of 241) of participants provided baseline data, and of these, 48% (109 of 225) were lost to follow-up in 1 year. Based on a complete case approach, this study included 116 participants who ranged in age from 18 to 66 years and 69% (80) of whom were women. The Traumatic Injuries Distress Scale (TIDS) was used to evaluate distress at baseline (within 4 weeks of injury). The TIDS is a validated, reliable 12-item risk prognosis screening tool that takes less than 3 minutes to complete with questions regarding uncontrolled pain, negative affect, and intrusion/hyperarousal. The minimum and maximum possible scores are 0 and 24, with higher scores indicating higher levels of distress. The Numeric Pain Rating Scale (NPRS) was used to assess the pain level at baseline and again 12 months postinjury. To complete the NPRS, participants rate the severity of their pain on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. NPRS scores of 1 to 3 indicate mild pain, 4 to 6 indicate moderate pain and 7 or higher indicate severe pain. As a preliminary analysis, to assess whether the participants as a group experienced recovery, a paired samples t-test was used to compare NPRS scores at baseline and 12 months. In all, 52% (60 of 116) of participants reported no pain (NPRS = 0), and mean pain intensity scores improved from 4.8 ± 2.1 at baseline to 1.6 ± 1.6 at 12-month follow-up (p < 0.001). Quantile regression was used to describe the association between baseline distress and pain levels 1 year after the injury. This technique was used because it reveals the relationships at different quantiles of the pain outcome distribution. RESULTS: The results indicate some people (52% [60 of 116]) recovered regardless of their baseline level of distress (30th quantile of the NPRS: ß = 0). However, in those with persisting pain, higher levels of baseline distress are associated with greater levels of pain 12 months after the injury (50th quantile of the NPRS: ß = 0.11; p = 0.01; 70th quantile of the NPRS: ß = 0.27; p < 0.001; 90th quantile of the NPRS: ß = 0.31; p = 0.01). According to this model, with a baseline TIDS score of 5, there is 10% probability that patients will report moderate or greater levels of pain (4 or higher of 10) 12 months later. This probability then increases as the TIDS score increases. For instance, at a score of 13 on the TIDS, the probability of a patient reporting moderate or higher levels of pain increases to 30%, and the probability of reporting severe pain (higher than 6 of 10) is 10%. CONCLUSION: Clinicians and surgeons in orthopaedic settings can screen for the presence of peritraumatic distress using the TIDS, which is an easily administered tool that does not require extensive knowledge of psychology, and by using it they can identify those with higher levels of distress who are more likely to have persistent, long-term pain. A score of 4 or less indicates a low risk of persistent pain, a score between 5 and 12 (endpoints included) indicates moderate risk, and a score of 13 or higher indicates high risk. Future studies should investigate whether certain immediate interventions for peritraumatic distress in the aftermath of trauma can decrease the likelihood that a patient will develop chronic pain after injury. As an analysis technique, quantile regression is useful to assess complex associations in many orthopaedic settings in which a certain outcome is expected to occur in most patients leading to non-normally distributed data. LEVEL OF EVIDENCE: Level II, therapeutic study.

Recovery Trajectories Following Complex Elbow Injuries and Radial Head Arthroplasty: A Longitudinal Study Over 8 Years.

PURPOSE: Radial head arthroplasty (RHA) is commonly performed to manage comminuted unreconstructible radial head fractures. Although the outcomes of RHA are often satisfactory, revisions are usually considered when pain intensity is higher than expected. Therefore, it is important to investigate the recovery trajectories of patients following RHA over an extended period and the characteristics that may lead to unfavorable outcomes. METHODS: The Patient-Rated Elbow Evaluation (PREE) was used to assess recovery in 94 patients at baseline (within 2-7 days after surgery); 3 and 6 months; and 1, 2, 3, 4, 5, and 8 years after RHA. Lower PREE values indicate lower pain and disability. Latent growth curve analysis was used to determine classes of recovery. The characteristics of the participants in the identified recovery trajectory classes were then compared. RESULTS: Two distinct recovery trajectories were identified: optimal and suboptimal recoveries. Most patients (84%) belonged to the optimal recovery class, which exhibited significantly lower baseline PREE scores, a consistent pattern of recovery, and a relatively high rate of change. Patients in the suboptimal recovery class (16%) had significantly higher baseline PREE scores and continued to experience relatively higher levels of pain and disability for the duration of the study; their rate of recovery was much slower. Patients belonging to the 2 recovery trajectories did not differ based on age or sex. Although we had low power in other variables, a qualitative exploration showed that the number of current or previous smokers was higher in the suboptimal recovery trajectory class. CONCLUSIONS: In this longitudinal cohort study, we show that high postsurgical pain and disability, and potentially smoking, may adversely affect the recovery trajectory following RHA. Clinicians are recommended to assess these potential factors while considering revision surgeries. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Prevalence of bone fractures among children and adolescents with attention-deficit/hyperactivity disorder: a systematic review and meta-analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a significant neurodevelopment disorder among children and adolescents, with 5 % prevalence. Bone fractures account for 25 % of accidents and injuries among all children and adolescents. Considering the characteristics of inattention, hyperactivity, and impulsivity in children with ADHD, it is critical to examine bone fractures among these children. The objective of our meta-analysis was to determine the prevalence of bone fractures among children and adolescents with ADHD. METHODS: We completed a systematic review and meta-analysis using an electronic search of the following databases: CINAHL, EMBASE, PsycINFO, PubMed, and Scopus. The search terms used were: "attention deficit hyperactivity disorder OR attention deficit disorder" and "bone fracture*." We included studies examining patients 18 years or younger who were diagnosed with ADHD and tracked (prospectively or retrospectively) for five or more years. Effect size (es), using a random effects model, was calculated. We registered the review protocol with PROSPERO (CRD42019119527). RESULTS: From 445 records retrieved, 31 full text articles were reviewed and 5 articles met inclusion criteria for meta-analysis. The summary es revealed the prevalence of bone fractures among children and adolescents with ADHD to be 4.83 % (95 % CI: 3.07-6.58 %). The location of bone fractures, using a subset of data, showed a distribution of 69.62 %, 22.85 %, and 7.53 % in the upper limbs, lower limbs, and other anatomical regions, respectively. Another subset of studies revealed a 2.55-fold increase in the prevalence of fractures among the children with ADHD compared to their counterparts. CONCLUSIONS: Awareness of these findings is critical to physicians, parents, and policy makers to create safe environments and provide supports in order to optimize the health and safety of children and adolescents with ADHD.

Measurement Properties of a 2-Dimensional Movement Analysis System: A Systematic Review and Meta-analysis.

OBJECTIVES: To critically appraise, compare, and summarize the quality of the measurement properties of the Dartfish software across various populations and motion tasks. DATA SOURCES: Systematic electronic searches were performed in the PsychInfo, Embase, Medline@Ovid, CINAHL, and Google Scholar databases from January 1999 to January 2020. STUDY SELECTION: Prospective measurement studies published in English peer-reviewed journals that reported on at least 1 psychometric property (reliability, validity, measurement error) using Dartfish were included. An independent reviewer performed searches and identified studies. DATA EXTRACTION: We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for abstracting and assessing data quality. Independent extraction was performed by 2 individual authors. The extracted data involved the author, year, study population, setting, sample size, and measurement properties, as well as information on camera positions, analyzed movement variables, and the corresponding strategy for addressing perspective error. DATA SYNTHESIS: In total, 23 studies were included in this review. Studies were pooled to examine inter-rater reliability estimates for different tasks: single-leg squat angle (2 studies, 115 participants; intra-class correlation coefficient [ICC], 0.94; 95% confidence interval [CI], 0.62-0.99), single-leg vertical drop jump angle (2 studies, 94 participants; ICC, 0.92; 95% CI, 0.20-0.99), and vertical drop jump angle (2 studies, 100 participants; ICC, 0.88; 95% CI, 0.83-0.92). Concurrent validity (2-dimensional Dartfish vs 3-dimensional Vicon) was established using the push and release task, single leg stance, and single leg stance with acutely induced dizziness in 45 healthy Parkinson patients. A correlation of 0.59 to 0.98 was reported. For tracking angles across various movements, a measurement error of approximately 10° retest variation was reported in 3 studies. CONCLUSION: Dartfish is a reliable software for assessing a variety of tasks across multiple contexts of assessments. Evidence suggests that the estimates of motion obtained with Dartfish are valid for single plane movements.

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review.

BACKGROUND: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. OBJECTIVE: To review gait parameters and characteristics associated with falls in people with dementia. METHODS: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. RESULTS: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. CONCLUSION: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

CaMKII mediates stimulus specificity in early odor preference learning in rats.

After naturalistic odor preference training, Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) was rapidly phosphorylated in the olfactory bulb, specifically in the odor encoding regions of the glomerular layer and external plexiform layer. Intrabulbar CaMKII antagonist experiments revealed that CaMKII supports short- and long-term preference memory formation. With bulbar PKA activation as the unconditioned stimulus odor preferences could be induced despite CaMKII blockade, but now odor specificity was lost, with odor preference generalizing to an untrained odor. Odor-specific learning was associated with increased membrane-associated AMPA receptors, while nonspecific odor preference was not. Thus CaMKII activation provides a tag to confer stimulus specificity as well as supporting natural odor preference learning.

Feasibility of pain informed movement program for people with knee osteoarthritis.

Objective: To establish the feasibility of an intervention consisting of neuromuscular exercise, mind-body techniques, and pain neuroscience education (PNE), referred to as Pain Informed Movement in people with knee Osteoarthritis (KOA). This program has the potential to improve our understanding of intrinsic pain modulation and its role in the management of chronic pain. Methods: This was a single-arm feasibility trial with a nested qualitative component. Primary outcome: complete follow-up. Inclusion criteria: age ≥40 years, KOA clinical diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10. The program consisted of 8-week in-person and at-home exercise sessions. PNE and mind-body techniques were provided as videos and integrated into the exercise sessions. Participants completed questionnaires and physical assessments including blood draws at baseline and program completion. Secondary feasibility outcomes: acceptability of the intervention, burden, rates of recruitment, compliance and adherence, and adverse events. A priori success criteria were identified. Participants were invited to an online focus group. Results: 19 participants were enrolled, with a complete follow-up rate of 74% (mean age 63.3 years (SD 10.5), 73% female), indicating modifications were necessary to proceed. All other success criteria were met. The focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations. Conclusion: The Pain Informed Movement program is deemed feasible, with minor modifications needed to proceed. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of Pain Informed Movement compared to conventional neuromuscular exercise and standard OA education.

Pain Informed Movement for people with knee osteoarthritis: Protocol for a pilot randomized controlled trial.

Objective: Conservative pain management strategies for knee osteoarthritis (KOA) have limited effectiveness and do not employ a pain-mechanism informed approach. Pain Informed Movement is a novel intervention combining mind-body techniques with neuromuscular exercise and pain neuroscience education (PNE), aimed at improving endogenous pain modulation. While the feasibility and acceptability of this program has been previously established, it now requires further evaluation in comparison to standard KOA care. Design: This protocol describes the design of a pilot two-arm randomized controlled trial (RCT) with an embedded qualitative component. The primary outcome is complete follow-up rate. With an allocation ratio of 1:1, 66 participants (33/arm) (age ≥40 years, KOA diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10), will be randomly allocated to two groups that will both receive 8 weeks of twice weekly in-person exercise sessions. Those randomized to Pain Informed Movement will receive PNE and mind-body technique instruction provided initially as videos and integrated into exercise sessions. The control arm will receive neuromuscular exercise and standard OA education. Assessment will include clinical questionnaires, physical and psychophysical tests, and blood draws at baseline and program completion. Secondary outcomes are program acceptability, burden, rate of recruitment, compliance and adherence, and adverse events. Participants will be invited to an online focus group at program completion. Conclusion: The results of this pilot RCT will serve as the basis for a larger multi-site RCT aimed at determining the program's effectiveness with the primary outcome of assessing the mediating effects of descending modulation on changes in pain.

Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version of the Satisfaction and Recovery Index (SRI): Structural Validity, Construct Validity, Internal Consistency, and Test-retest Reliability.

Background: The Satisfaction and Recovery Index (SRI) is a generic importance-weighted health satisfaction tool to measure the process and state of recovery following musculoskeletal injuries. The objectives of this study are (1) to translate and cross-culturally adapt the SRI to Persian and (2) evaluate its psychometric properties. Methods: The forward-backward translation technique was used for translation, and two rounds of cognitive interviews were conducted to assess cultural appropriateness. Participants (n=100, mean age=32.5, 82%male) had acute (i.e., <30 days) musculoskeletal injuries of any etiology. Structural validity, construct validity, internal consistency, and test-retest reliability were evaluated. Results: Participants identified issues in 3/6 areas of a coding system during the cognitive interviews: comprehension/clarity, relevance, and inadequate response definition. These issues informed subsequent changes to arrive at the final version of the SRI-P. The SRI-P had adequate construct validity (P<0.001), the confirmatory factor analysis demonstrated a two-factor structure, the internal consistency was acceptable (Cronbach's α=0.83), and it was deemed reliable (ICC2, 1=0.72). Conclusion: The psychometric evaluation revealed that the SRI-P has adequate construct validity, internal consistency, and test-retest reliability. Unlike the original English version, the SRI-P has a two-factor structure, which appears to be related to cultural differences in interpreting some of the items. The clinical importance of this study is that the SRI (which captures the state of recovery and how important the various items of the tool are to each patient and how satisfied they are with their recovery) can now be available to surgeons and therapists in the orthopedic and rehabilitation realms in Persian populations.

Exploring Social Determinants of Posttraumatic Pain, Distress, Depression, and Recovery Through Cross-Sectional, Longitudinal, and Nonlinear Trends.

OBJECTIVES: Pain, distress, and depression are predictors of posttrauma pain and recovery. We hypothesized that pretrauma characteristics of the person could predict posttrauma severity and recovery. METHODS: Sex, age, body mass index, income, education level, employment status, pre-existing chronic pain or psychopathology, and recent life stressors were collected from adults with acute musculoskeletal trauma through self-report. In study 1 (cross-sectional, n=128), pain severity was captured using the Brief Pain Inventory (BPI), distress through the Traumatic Injuries Distress Scale (TIDS) and depression through the Patient Health Questionnaire-9 (PHQ-9). In study 2 (longitudinal, n=112) recovery was predicted using scores on the Satisfaction and Recovery Index (SRI) and differences within and between classes were compared with identify pre-existing predictors of posttrauma recovery. RESULTS: Through bivariate, linear and nonlinear, and regression analyses, 8.4% (BPI) to 42.9% (PHQ-9) of variance in acute-stage predictors of chronicity was explainable through variables knowable before injury. In study 2 (longitudinal), latent growth curve analysis identified 3 meaningful SRI trajectories over 12 months. Trajectory 1 (start satisfied, stay satisfied [51%]) was identifiable by lower TIDS, BPI, and PHQ-9 scores, higher household income and less likely psychiatric comorbidity. The other 2 trajectories (start dissatisfied, stay dissatisfied [29%] versus start dissatisfied, become satisfied [20%]) were similar across most variables at baseline save for the "become satisfied" group being mean 10 years older and entering the study with a worse (lower) SRI score. DISCUSSION: The results indicate that 3 commonly reported predictors of chronic musculoskeletal pain (BPI, TIDS, PHQ-9) could be predicted by variables not related to the injurious event itself. The 3-trajectory recovery model mirrors other prior research in the field, though 2 trajectories look very similar at baseline despite very different 12-month outcomes. Researchers are encouraged to design studies that integrate, rather than exclude, the pre-existing variables described here.

What are the mental health changes associated with the COVID-19 pandemic in people with medical conditions? An international survey.

OBJECTIVES: The COVID-19 pandemic has negatively impacted mental health worldwide but there is paucity of knowledge regarding the level of change in mental health in people with a medical condition (physical/psychiatric). The objectives of this study were (1) to compare the change in mental health in people with and without medical conditions, (2) to assess the change in various types of medical conditions, (3) to evaluate the association between change in mental health and number of comorbidities, and (4) to investigate the influence of receiving treatment and activity limitation imposed by the medical condition(s). DESIGN: Cross-sectional. SETTING: Online international survey. PARTICIPANT: English-speaking adults (age ≥18) were included in the study, with no exclusions based on sex/gender or location. 1276 participants (mean age 30.4, 77.7% female) were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Pre and during COVID-19 pandemic symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9) were assessed. The Self-Administered Comorbidity Questionnaire was used to collect data regarding medical conditions.Repeated-measures analysis of covariance (objectives 1, 2 and 4) and Pearson's correlation coefficient (objective 3). RESULTS: 50.1% of participants had a medical condition. During the COVID-19 pandemic, compared with people with no medical condition, people with both psychiatric and physical conditions experienced significantly higher symptoms of anxiety (12%, p=0.009) and depression (9.4%, p<0.001). Although not statistically significant, the increase in anxiety and depression occurred across seven major categories of conditions. An association was found between having a higher number of medical conditions with higher anxiety and depression symptoms (r=0.16 anxiety, r=0.14 depression, p<0.001). Receiving treatment and being functionally limited by the disease did not have a significant impact on the amount of change (p>0.05). CONCLUSIONS: During the COVID-19 pandemic, people who had a combination of psychiatric and physical conditions experienced greater symptoms of anxiety and depression. Patients with chronic diseases may need extra support to address their mental health as a result of the pandemic.

Reliability, discriminative accuracy, and an exploration of response shift as measured using the satisfaction and Recovery Index over 12 months from musculoskeletal trauma.

PURPOSE: The Satisfaction and Recovery Index (SRI) is an importance-weighted health-related satisfaction tool intended to be a patient-centric means to capture both the process and state of recovery following musculoskeletal trauma. The purpose of this study was to explore measurement invariance, responsiveness, discriminative accuracy, and potential response shift identifiable within the SRI. METHODS: Participants were 111 adults with acute musculoskeletal trauma. Data were collected at baseline, and again at 1, 2, 3, 6, and 12 months post-injury. Other tools used were the Brief Pain Inventory (BPI) and a Global Rating of Change scale. 1-month test-retest reliability (ICC2,1), responsiveness (standardized response mean in stable vs. changed participants), discriminative accuracy (area under the curve for differentiating between recovered and non-recovered), and response shift (change in mean importance scores over the 12-month period) were explored. All but the final analysis were compared against the BPI. RESULTS: Test-retest reliability was excellent across all metrics (ICC2,1 = 0.83 to 0.88). Responsiveness was greatest for the weighted SRI (SRM = 0.36) with MDC95 of 13.7%. All tools showed significant ability to discriminate between participants nominating recovery vs. non-recovery (AUC≥0.69) though the BPI subscales were significantly better than the SRI. Importance ratings showed small but significant change over time in 7 of the 9 SRI items. CONCLUSION: This study provides support for the SRI as a useful tool for evaluating recovery, though it seems more valuable for capturing the process rather than state of recovery. While response shift was small, there is enough reason to endorse retention of the importance ratings.

A Systematic Review and Synthesis of Psychometric Properties of the Numeric Pain Rating Scale and the Visual Analog Scale for Use in People With Neck Pain.

OBJECTIVES: To conduct a systematic search and synthesis of evidence about the measurement properties of the Numeric Pain Rating Scale (NPRS) and the Visual Analog Scale (VAS) as patient-reported outcome measures in neck pain research. METHODS AND MATERIALS: CINAHL, Embase, PsychInfo, and MedLine databases were searched to identify studies evaluating the psychometric properties of the NPRS and the VAS used in samples of which >50% of participants were people with neck pain. Quality and consistency of findings were synthesized to arrive at recommendations. RESULTS: A total of 46 manuscripts were included. Syntheses indicated high-to-moderate-quality evidence of good-to-excellent (intraclass correlation coefficient 0.58 to 0.93) test-retest reliability over an interval of 7 hours to 4 weeks. Moderate evidence of a clinically important difference of 1.5 to 2.5 points was found, while minimum detectable change ranged from 2.6 to 4.1 points. Moderate evidence of a moderate association (r=0.48 to 0.54) between the NPRS or VAS and the Neck Disability Index. Findings from other patient-reported outcomes indicated stronger associations with ratings of physical function than emotional status. There is limited research addressing the extent that these measures reflect outcomes that are important to patients. DISCUSSION: It is clear NPRS and the VAS ratings are feasible to implement, provide reliable scores and relate to multi-item patient-reported outcome measures. Responsiveness (meaningful change) of the scales and interpretation of change scores requires further refinement. The NPRS can be a useful single-item assessment complimenting more comprehensive multi-item patient-reported outcome measures in neck pain research and practice.

The role of sex and gender in the changing levels of anxiety and depression during the COVID-19 pandemic: A cross-sectional study.

BACKGROUND: Several studies have assessed the impact of the COVID-19 pandemic on anxiety and depression, but have not focused on the role of sex and gender. This study compared changes in the levels of anxiety and depression (pre- and post-COVID) experienced by individuals of various sexes and genders. METHODS: We used a cross-sectional online survey that assessed pre- and post-COVID symptoms of anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-9). General linear modeling (fixed model factorial analysis of variance) was used to evaluate changes in anxiety and depression between pre- and post-pandemic periods and explore differential effects of sex and gender on those changes. RESULTS: Our study included 1847 participants from 43 countries and demonstrated a percentage increase of 57.1% and 74.2% in anxiety and depression, respectively. For the Generalized Anxiety Disorder-2 scale (maximum score 6), there was a mean increase in anxiety by sex for male, female, and other of 1.0, 1.2, and 1.4, respectively; and by gender for man, woman, and others of 0.9, 1.3, and 1.6, respectively. For the Patient Health Questionnaire-9 (maximum score 27), there was a mean increase in depressive symptoms by sex for male, female, and other of 3.6, 4.7, and 5.5 respectively; and by gender for man, woman, and others of 3.3, 4.8, and 6.5, respectively. CONCLUSION: During COVID-19, there was an increase in anxiety and depressive symptoms for all sexes and genders, with the greatest increases reported by those identifying as non-male and non-men.

Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis.

BACKGROUND: Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE: To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS: Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS: The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION: Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.