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1.
Bone Joint J ; 102-B(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888361

RESUMO

AIMS: Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture. METHODS: A total of 744 adults with an isolated fracture of the proximal humerus, elbow, or distal radius completed PROMs. Due to multicollinearity of patient engagement and psychosocial variables, we generated a single variable combining measures of engagement and psychosocial factors using factor analysis. We then performed multivariable analysis with p < 0.10 on bivariate analysis. RESULTS: Patient engagement and psychosocial factors combined to form a single factor (factor 1) accounting for 20% (QuickDASH, semi-partial R2 = 0.20) and 14% (PROMIS UE PF, semi-partial R2 = 0.14) of the variation in limitations six to nine months after fracture. Factor 1 also accounted for 17% (NRS-C, semi-partial R2 = 0.17) of variation in satisfaction with care, and 21% (NRS-S, semi-partial R2 = 0.21) of variation in satisfaction with services. Demographic factors (age, sex, work status) and measures of greater pathophysiology (type of fracture, high-energy injury, post-surgical complications), accounted for much less variation. CONCLUSION: Patients who actively manage their health and demonstrate effective emotional and social functioning share a common underlying trait. They have fewer limitations and greater satisfaction with care during recovery from upper limb fractures. Future efforts should focus on evaluating initiatives that optimize patient engagement, such as patient education, coaching, and a communication strategy for healthcare professionals. Cite this article: Bone Joint J 2020;102-B(1):42-47.


Assuntos
Articulação do Cotovelo/lesões , Comportamentos Relacionados com a Saúde , Fraturas do Úmero/cirurgia , Fraturas Intra-Articulares/cirurgia , Participação do Paciente , Fraturas do Rádio/cirurgia , Atividades Cotidianas , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Ósseas , Promoção da Saúde , Humanos , Fraturas do Úmero/psicologia , Fraturas Intra-Articulares/psicologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Estudos Prospectivos , Fraturas do Rádio/psicologia , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
2.
BMC Musculoskelet Disord ; 19(1): 202, 2018 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-29940926

RESUMO

BACKGROUND: Distal radius fractures (DRF) account for nearly one-fifth of all fractures in older adults, and women experience them 5× as often as men. Most DRF occur with low impact injuries to the wrist with an outstretched hand, and are often managed via closed treatment and cast immobilization. Women sustaining a DRF are at risk for upper limb immobility, sensorimotor changes, edema and type I complex regional pain syndrome (CRPS). Since CRPS onset is likely influenced by alterations in the brain's somatosensory region, a rehabilitation intervention, Graded Motor Imagery (GMI), aims to restore cortical representation, including sensory and motor function, of the affected limb. To date, there are no studies on the use of GMI in reducing risk of or preventing the onset of type I CRPS in women with DRF treated with cast immobilization. Due to a higher likelihood of women with this injury developing type I CRPS, it is important to early intervention is needed. METHODS/DESIGN: This article describes a six-week randomized comparative effectiveness trial, where the outcomes of a modified GMI program (mGMI) + standard of care (SOC) group (n = 33) are compared to a SOC only control group (n = 33). Immediately following cast immobilization, both groups participate in four 1-h clinic-based sessions, and a home program for 10 min three times daily until cast removal. Blinded assessments occur within 1 week of cast immobilization (baseline), at three weeks post cast immbolization, cast removal, and at three months post cast removal. The primary outcomes are patient reported wrist/hand function and symptomology on the Patient Rated Wristand Hand Evaluation, McGill Pain Questionnaire, and Budapest CRPS Criteria. The secondary outcomes are grip strength, active range of motion as per goniometry, circumferential edema measurements, and joint position sense. DISCUSSION: This study will investigate the early effects of mGMI + SOC hand therapy compared to SOC alone. We intend to investigate whether an intervention, specifically mGMI, used to treat preexisiting pain and motor dysfunction might also be used to mitigate these problems prior to their onset. If positive effects are observed, mGMI + SOC may be considered for incorporation into early rehabilitation program. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov with identifier NCT02957240 (Approval date: April 20, 2017).


Assuntos
/métodos , Movimento/fisiologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/terapia , Distrofia Simpática Reflexa/psicologia , Distrofia Simpática Reflexa/terapia , Método Duplo-Cego , Feminino , Humanos , Fraturas do Rádio/complicações , Distrofia Simpática Reflexa/etiologia , Resultado do Tratamento
3.
Hand Surg Rehabil ; 37(3): 167-170, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29580686

RESUMO

We investigated the relationship between pain and hesitation during movement initiation among 11 adult female patients who had undergone surgery for a distal radius fracture. Data on the patients' pain at rest, pain during movement and score on the Pain Catastrophizing Scale were analyzed. Movement characteristics were assessed by the administration of a finger tapping (FT) task using the thumb and index finger, with the movement repeated 10 times, recorded and analyzed to determine the patient's hesitation when opening or closing her thumb/forefinger during the task. Hesitation of movement initiation was significantly correlated with subjective factors such as pain at rest, pain during movement, and rumination. Pain was not significantly correlated with the physical range of motion. Our findings suggest that hesitation during movement initiation for the FT task may be a type of behavior that is affected by subjective pain. Movement hesitation is a novel clinical sign indicating the possible progression of acute pain into chronic pain. The kinematic evaluation described herein is a convenient clinical measurement that captures a subjective factor.


Assuntos
Movimento/fisiologia , Dor/psicologia , Fraturas do Rádio/psicologia , Idoso , Feminino , Fixação de Fratura , Humanos , Dor/fisiopatologia , Período Pós-Operatório , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Escala Visual Analógica
4.
Clin Rehabil ; 32(6): 841-851, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29400071

RESUMO

OBJECTIVE: To investigate patients' experience following wrist fracture, surgical repair and immobilization. DESIGN: A qualitative investigation involving individual participant interviews. SETTING: A metropolitan trauma service. SUBJECTS: In all, 31 participants were consecutively recruited from three groups within a randomized controlled trial comparing immobilization for one ( n = 11), three ( n = 10) or six weeks ( n = 10) following surgical treatment for wrist fracture. INTERVENTION: Individual interviews were conducted within three months of cast removal. Questions prompted discussion of the experience of fracture, surgery and immobilization. Interviews were audio-recorded, transcribed verbatim. At least two independent researchers performed coding and theming following principles of thematic analysis. RESULTS: Two themes were identified: (1) impact of the injury varies widely and (2) health care consumers want trustworthy dialogue. Participant reports indicated that recovery from wrist fracture, surgery and immobilization is challenging with significant changes to social role and increased dependence. For many, lack of empathy from health professionals and limited acknowledgement of the personal impact of injury led to dissatisfaction. Health professionals did not consistently tailor communication or adopt strategies to address specific needs for pain management, education and support requirements. There was no evidence that processes were implemented to enhance participant recall and comprehension. Most participants experienced their cast as a barrier to function. However, within the group of participants immobilized for one week, a number felt the cast was removed too soon. CONCLUSION: Participant reports indicate that recovery from surgically repaired wrist fracture is challenging. Opportunities exist to refine care in pain management, education and active engagement of patients in their care.


Assuntos
Moldes Cirúrgicos , Imobilização , Fraturas do Rádio/psicologia , Traumatismos do Punho/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Cuidados Pós-Operatórios , Relações Profissional-Paciente , Fraturas do Rádio/terapia , Papel (figurativo) , Traumatismos do Punho/terapia
5.
Clin Orthop Relat Res ; 476(4): 744-750, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29419627

RESUMO

BACKGROUND: Complex regional pain syndrome (CRPS) is frequently diagnosed in patients recovering from surgery or injury. The symptoms and signs included in consensus diagnostic criteria for CRPS are expected after injury. Categorizing symptoms and signs that occur on a continuum as disproportionate or not is subjective and prone to bias. Psychiatrists and psychologists do not diagnose CRPS and instead measure and treat anxiety and catastrophic thinking on its continuum. Given the expected variation in subjective diagnoses such as CRPS, this study addresses factors associated with use of this diagnosis and how it influences care. QUESTIONS/PURPOSES: (1) Among patients recovering from fracture of the distal radius, what factors are associated with the diagnosis of CRPS? (2) Are patients diagnosed with CRPS after distal radius fractures, as opposed to those without CRPS, more likely to have a bone scan, stellate ganglion block, therapy, or subsequent surgery? METHODS: Using the Truven database, we identified 59,765 patients treated for a distal radius fracture from 2012 to 2014, of whom 114 (0.19%) were diagnosed with CRPS. The Truven Health MarketScan database is an administrative claims data set of commercially insured patients and this analysis only included patients with complete enrollment from 2012 through 2014. Bivariate analyses sought differences between patients diagnosed with and patients not diagnosed with CRPS. All factors with p < 0.05 were included in a multivariable logistic regression model. RESULTS: The covariates older age (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.011-1.048; p = 0.002), gender (women at greater risk, OR, 3.86; CI, 1.99-7.49; p < 0.001), concomitant fracture of the distal ulna (OR, 1.54; CI, 1.05-2.23; p = 0.029), open fracture (OR, 0.414; CI, 0.192-0.895; p = 0.025), and comorbid fibromyalgia (OR, 16.0; CI, 4.92-51.8; p < 0.001) were independently associated with a diagnosis of CRPS among patients recovering from a fracture of the distal radius. Patients diagnosed with CRPS are more likely than other patients with a distal radius fracture to have had a bone scan (OR, 66.0; CI, 8.19-532; p < 0.001), physical or occupational therapy (OR, 3.89; CI, 2.68-5.67; p < 0.001), and subsequent wrist surgery (OR, 2.52; CI, 1.65-3.84; p < 0.001). No one had a stellate ganglion injection. CONCLUSIONS: We found that a coded diagnosis of CPRS is uncommonly applied to patients on the higher range of pain, stiffness, and limitations after fracture of the distal radius-most commonly in women and in association with another nonspecific, objectively unverifiable diagnosis (fibromyalgia)-and that this label may lead to more testing and invasive treatment. Future research should address the utility and value of diagnoses that create subjective categories for aspects of human illness that occur on a continuum. LEVEL OF EVIDENCE: Level III, prognostic study.


Assuntos
Síndromes da Dor Regional Complexa/diagnóstico , Fibromialgia/epidemiologia , Fraturas do Rádio/terapia , Demandas Administrativas em Assistência à Saúde , Adolescente , Adulto , Fatores Etários , Comorbidade , Síndromes da Dor Regional Complexa/epidemiologia , Síndromes da Dor Regional Complexa/fisiopatologia , Síndromes da Dor Regional Complexa/psicologia , Bases de Dados Factuais , Feminino , Fibromialgia/diagnóstico , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/psicologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
6.
Clin Orthop Relat Res ; 476(4): 832-845, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29406451

RESUMO

BACKGROUND: Symptom intensity and magnitude of limitations correlate with stress, distress, and less effective coping strategies. It is unclear if interventions to target these factors can be used to improve outcomes after distal radius fracture in either the short- or longer term. QUESTIONS/PURPOSES: (1) Are there any factors (including the use of a workbook aimed at optimizing psychological response to injury, demographic, radiographic, medical, or psychosocial) associated with improved Disabilities of the Arm, Shoulder and Hand (DASH) and Numerical Rating Scale pain (NRS pain) scores at 6 weeks after management of distal radius fracture? (2) Are any of these factors associated with improved DASH and NRS pain scores at 6 months after management of distal radius fracture? METHODS: We conducted a double-blind randomized controlled trial comparing a workbook designed to optimize rehabilitation by improving psychological response to injury using recognized psychological techniques (the LEARN technique and goal setting) versus a workbook containing details of stretching exercises in the otherwise routine management of distal radius fracture. Patients older than 18 years of age with an isolated distal radius fracture were recruited within 3 weeks of injury from a single academic teaching hospital between March and August 2016. During recruitment, 191 patients who met the inclusion criteria were approached; 52 (27%) declined participation and 139 were enrolled. Eight patients (6%) were lost to followup by 6 weeks. The remaining cohort of 129 patients was included in the analysis. DASH scores and NRS pain scores were recorded at 6 weeks and 6 months after injury. Multivariable regression analysis was used to identify factors associated with outcome scores. RESULTS: At 6 weeks after distal radius fracture, when compared with an information-only workbook, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 38 [range, 21-48]; control DASH: 35 [range, 21-53]; difference of medians: 3; p = 0.949) nor NRS pain scores (workbook NRS: 3 [range, 1-5]; control NRS: 2 [range, 1-4]; difference of medians: 1; p = 0.128). Improved DASH scores were associated with less radial shortening (ß = 0.2, p = 0.009), less dorsal tilt (ß = 0.2, p = 0.035), and nonoperative treatment (ß = 0.2, p = 0.027). Improved NRS pain scores were associated with nonoperative treatment (ß = 0.2, p = 0.021) and no posttraumatic stress disorder (PTSD) (ß = 0.2, p = 0.046). At 6 months, use of a psychologic workbook was not associated with improved DASH (workbook DASH: 11 [range, 5-28]; control DASH: 11 [range, 3-20]; difference of medians: 0; p = 0.367) nor NRS pain scores (workbook NRS: 1 [range, 0-2]; control NRS: 1 [range, 0-2]; difference of medians: 0; p = 0.704). Improved DASH score at 6 months was associated with having fewer medical comorbidities (ß = 0.3, p < 0.001) and lower enrollment PTSD (ß = 0.3, p < 0.011). Lower NRS pain scores at 6 months were associated with having fewer medical comorbidities (ß = 0.2, p = 0.045), lower enrollment PTSD (ß = 0.3, p = 0.008), and lower enrollment Tampa Scale for Kinesiophobia (ß = 0.2, p = 0.042). CONCLUSIONS: Our study demonstrates that there is no benefit from the untargeted use of a psychological workbook based on the LEARN approach and goal-setting strategies in patients with distal radius fracture. Future research should investigate if there is a subgroup of patients with a negative psychological response to injury that benefits from psychological intervention and, if so, how best to identify these patients and intervene. LEVEL OF EVIDENCE: Level II, therapeutic study.


Assuntos
Braço/fisiopatologia , Mãos/fisiopatologia , Dor Musculoesquelética/terapia , Fraturas do Rádio/terapia , Autocuidado/métodos , Ombro/fisiopatologia , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Método Duplo-Cego , Terapia por Exercício , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/fisiopatologia , Dor Musculoesquelética/psicologia , Medição da Dor , Educação de Pacientes como Assunto , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/psicologia , Recuperação de Função Fisiológica , Escócia , Autoeficácia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Arch Osteoporos ; 12(1): 42, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28421547

RESUMO

Patients with inadequate health literacy, those with medical comorbidities, or those with a previous history of adverse drug events have a higher likelihood of non-adherence to osteoporosis treatment after sustaining a distal radius fracture. INTRODUCTION: Patients with a distal radial fracture (DRF) have a higher risk of subsequent fractures, which provides an important opportunity to begin treatment for osteoporosis. This study assessed the effect that health literacy of patients suffering from a DRF has on the subsequent adherence to osteoporosis treatment. METHODS: A total of 116 patients (female, over 50 years of age) presenting a DRF caused by low-energy trauma were enrolled. Their health literacy was measured using the Newest Vital Sign (NVS). Alendronate (70 mg, orally, once weekly) was prescribed to all patients for 1 year, and adherence was defined as taking at least 80% of the tablets for 12 months and returning for the visit on month 12. Multivariable analyses were conducted to determine whether the patients' clinical, demographic, and health literacy factors influenced their adherence to osteoporosis treatment. RESULTS: About half (52%) of the participants who sustained a DRF exhibited an inadequate health literacy, and the rate of non-adherence to osteoporosis treatment was 38%. The rate of non-adherence for patients with inadequate literacy was significantly higher than for those with appropriate literacy (47 vs. 29%, p = 0.04). The results of the regression analysis indicate that limited health literacy, the presence of comorbidities, and prior history of adverse drug events are associated with a higher likelihood of non-adherence to osteoporosis treatment after sustaining a DRF. CONCLUSIONS: Patients with inadequate health literacy, adverse drug events, or medical comorbidities had higher rates of non-adherence with alendronate treatment after sustaining a DRF. Further research is needed to show whether improvements in patient comprehension via informational intervention in patients with a DRF will improve adherence to osteoporosis treatment.


Assuntos
Alfabetização em Saúde , Osteoporose/psicologia , Cooperação do Paciente/estatística & dados numéricos , Fraturas do Rádio/psicologia , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Comorbidade , Feminino , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Fraturas do Rádio/etiologia , Análise de Regressão
8.
Injury ; 48(3): 731-737, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28179058

RESUMO

INTRODUCTION: Malunion occurs in approximately 23% of non-operatively treated and 11% of operatively treated distal radius fractures. The decision whether to correct a malunion is primarily based on functional impairment and wrist pain. The purpose of this study was to assess the long-term functional outcomes of corrective osteotomies for symptomatic malunited distal radius fractures. METHODS: All consecutive corrective osteotomies of the distal radius performed in one centre between January 2009 and January 2016 were included. The primary outcome was the functional outcome assessed with the Disability of the Arm, Shoulder and Hand (DASH) and the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes were range of motion, grip strength, pain as indicated on the Visual Analogue Scale (VAS) before and after corrective osteotomy, radiological parameters, time to union and complications. Additionally, we aimed to determine if there were any difference in graft versus no graft usage. RESULTS: A total of 48 patients were included. The median age was 54.5 years (IQR 39-66) and 71% was female. The median time to follow-up was 27 months. The median DASH and PRWE score were respectively 10.0 (IQR 5.8-23.3) and 18.5. (6.5-37.0). Except for pronation and supination, range of motion and grip strength of the injured wrist were significantly less compared to the uninjured side. Palmar and dorsal flexion and radial and ulnar deviation of the injured wrist were significantly less compared with the uninjured side. VAS pain scores decreased significantly from 6.5 preoperative to 1.0 postoperative. The median time to union was 23 weeks (IQR 12-29.5). Eighteen patients (38%) had a complication for which additional treatment was required. Except for a significant difference in radial inclination and length after the corrective osteotomy in favour of graft usage, there were no significant differences between graft an no graft usage. CONCLUSIONS: Corrective osteotomy is an effective method of treating symptomatic distal radius malunions with good long-term functional results, measured with the DASH and PRWE score, and improvement in radiographic parameters and pain scores. Additionally, no differences in functional outcomes were found between graft and no graft usage.


Assuntos
Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas Mal-Unidas/cirurgia , Osteotomia , Satisfação do Paciente/estatística & dados numéricos , Fraturas do Rádio/cirurgia , Articulação do Punho/fisiopatologia , Adulto , Avaliação da Deficiência , Feminino , Seguimentos , Fraturas Mal-Unidas/epidemiologia , Fraturas Mal-Unidas/fisiopatologia , Fraturas Mal-Unidas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Osteotomia/métodos , Medição da Dor , Radiografia , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/psicologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
9.
J Orthop Trauma ; 30(5): 228-33, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27101161

RESUMO

OBJECTIVES: This study examines depression and outcomes in patients older than 55 years with distal radius fracture. DESIGN: Prospective data collection included patient characteristics, treatment, general and limb symptoms and disability, and complications at baseline, 3 months, and 1 year. Bivariate analysis and multivariable linear regression were used to assess relationships between depression and outcome measures, specifically the Short Form-36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH) scores, and the Centre of Epidemiologic Studies Depression (CES-D) scale. SETTING: The study was conducted in a level-1 trauma center. PARTICIPANTS: All patients older than 55 years with isolated distal radius fracture were recruited (2007-2011). INTERVENTION: Patients were treated operatively or nonoperatively. MAIN OUTCOME MEASURES: The SF-36 and DASH scores measured general and upper extremity status. Depression was measured using CES-D scale. All complications were recorded. RESULTS: Of 228 patients, 25% were depressed at baseline, 32% at 3 months, and 26% after 1 year. Thirty-two patients (14%) had complications. There was no relationship between depression at baseline and complications; however, there was a statistically significant relationship at 3 months (P = 0.021). There was a statistically significant association between baseline depression and the worse 1-year SF-36. Patients with baseline depression had poorer 1-year DASH scores (20 ± 2.3) than nondepressed patients (11 ± 1.3) (P = 0.0031), and less improvement in DASH scores over the first year (P = 0.023). Multivariable linear regression demonstrated that baseline depression is the strongest predictor of poorer 1-year DASH scores (3.7, P = 0.0078) and change in DASH scores over the first year (2.9, P = 0.026). CONCLUSIONS: Baseline depression predicts worse function and disability outcomes 1 year from injury. Depression (CES-D ≥16) is the strongest predictor of worse 1-year DASH scores and SF-36 outcome measures, after controlling for other potential predictors. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Depressão/psicologia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida/psicologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/terapia , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica/epidemiologia , Causalidade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Fraturas do Rádio/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
J Surg Orthop Adv ; 24(3): 164-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26688986

RESUMO

The purpose of this study was to evaluate midterm outcomes after both bone forearm fractures. A retrospective review of patients treated with open reduction and internal fixation (ORIF) at three level 1 trauma centers was completed. Eligible patients were sent three questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Short Form-12 (SF-12), and questions about postinjury experience. Twenty-nine patients with an average age of 45 years returned the materials. The forms were completed an average of 60 months after ORIF. The mean DASH was 22 for all respondents. Twenty-one subjects participated in physical therapy (72%). Eight patients (28%) screened positive for posttraumatic stress disorder (PTSD). The mean SF-12 physical component score was 39 and the SF-12 mental component score was 40, both of which were lower than the non-PTSD group, indicating a lower subjective level of health (p < .05). The data suggest that, years after surgery, patients have decreased functional outcomes.


Assuntos
Fixação Interna de Fraturas , Modalidades de Fisioterapia , Fraturas do Rádio/terapia , Fraturas da Ulna/terapia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , Fraturas do Rádio/psicologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/psicologia , Resultado do Tratamento , Fraturas da Ulna/complicações , Fraturas da Ulna/psicologia , Adulto Jovem
11.
Health Qual Life Outcomes ; 13: 158, 2015 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-26416429

RESUMO

BACKGROUND: A distal radius fracture (DRF) is a common injury that can cause significant pain and lead to a prolonged decrease in physical, emotional, and social functioning. In modern randomized clinical trials, assessing outcomes after a DRF, health-related quality-of-life (HRQoL) is a "must-be" endpoint. Additionally, HRQoL assessments are essential in the clinical decision-making process. The aim of this study to cross-culturally adapt the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a DRF to Polish. METHODS: A standard forward-backward translation procedure and pilot-testing were used to prepare the Polish version of the IOF QLQ for use in this case-control study. Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. The study group was gender and aged matched with healthy controls. All DRF patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3, 6, 12, and 18 months after the fracture. Standard validity and reliability analyses were performed. RESULTS: Ninety-seven patients (73 women - 75.3%) with a mean age of 62.4 ± 7.1 years agreed to take part in the study. The control group consisted of 81 patients (60 women - 74.1%) with a mean age 63.9 ± 8.2 years. No significant differences were found between the mean age of patients and controls (p = 0.19). Cronbach's alpha coefficients showed positive internal consistency (0.79-0.89). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.85 to 0.92. Satisfactory convergent and discriminant validity of the IOF QLQ was seen. CONCLUSIONS: The Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring HRQoL. It can be fully recommended for use in clinical settings in the Polish population. When combined with the SF-36 the IOF QLQ allows to obtain a comprehensive HRQoL assessment in patients with a DRF.


Assuntos
Nível de Saúde , Qualidade de Vida/psicologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/reabilitação , Inquéritos e Questionários/normas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comparação Transcultural , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Psicometria , Reprodutibilidade dos Testes , Fatores Sexuais , Traduções , Adulto Jovem
12.
Psychosomatics ; 56(6): 652-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26002224

RESUMO

OBJECTIVES: To test the difference in symptoms of (1) depression, (2) health anxiety, and (3) catastrophic thinking between 1 and 6 weeks after injury to the radius. PATIENTS AND METHODS: In total, 69 adult patients with a minimally displaced radial head or distal radius fracture were prospectively enrolled. After diagnosis, we recorded demographic variables, 11-point ordinal numerical pain score, and agreement with "no pain, no gain"; Disabilities of the Arms, Shoulder, and Hand (DASH) questionnaire; Center for Epidemiologic Studies Depression Scale; the Whiteley Index; and the Pain Catastrophizing Scale. In total, 55 patients (80%) returned after 1 month to reevaluate pain, Disabilities of the Arms, Shoulder, and Hand, Center for Epidemiologic Studies Depression, Whiteley Index, and Pain Catastrophizing Scale scores. RESULTS: Center for Epidemiologic Studies Depression scores decreased by an average of 5 ± 9 points (p < 0.001), and Pain Catastrophizing Scale scores decreased by 2 ± 6 points (p = 0.0041). In multivariable analysis, decrease in Center for Epidemiologic Studies Depression was associated with not having an additional pain condition, more days elapsed between injury and final evaluation, and stronger agreement with "no pain, no gain" (adjusted R(2) = 0.26, p = 0.0006). An increase in Whiteley scores was associated with fewer years of education (R = -0.34, p = 0.012). Changes in Pain Catastrophizing Scale scores were associated with marital status (single -1.7 ± 4.3 vs married -4.6 ± 6.0 vs separated 0.55 ± 6.2, p = 0.040). CONCLUSIONS: Symptoms of depression and catastrophic thinking, but not health anxiety, improved during recovery after injury. If psychologic measures are used as a screening tool to predict outcome after treatment, one should account for a patient's disease phase. LEVEL OF EVIDENCE: Prognostic level I.


Assuntos
Ansiedade/psicologia , Catastrofização/psicologia , Depressão/psicologia , Dor/psicologia , Fraturas do Rádio/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/complicações , Catastrofização/complicações , Depressão/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Fraturas do Rádio/complicações , Inquéritos e Questionários , Adulto Jovem
13.
J Orthop Trauma ; 29(10): e414-20, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25866942

RESUMO

OBJECTIVES: To identify demographic, injury-related, or psychologic factors associated with finger stiffness at suture removal and 6 weeks after distal radius fracture surgery. We hypothesize that there are no factors associated with distance to palmar crease at suture removal. DESIGN: Prospective cohort study. SETTING: Level I Academic Urban Trauma Center. PATIENTS: One hundred sixteen adult patients underwent open reduction and internal fixation of their distal radius fractures; 96 of whom were also available 6 weeks after surgery. INTERVENTION: None. MAIN OUTCOME MEASUREMENTS: At suture removal, we recorded patients' demographics, AO fracture type, carpal tunnel release at the time of surgery, pain catastrophizing scale, Whiteley Index, Patient Health Questionnaire-9, and disabilities of the arm, shoulder, and hand questionnaire, 11-point ordinal measure of pain intensity, distance to palmar crease, and active flexion of the thumb through the small finger. At 6 weeks after surgery, we measured motion, disabilities of the arm, shoulder, and hand, and pain intensity. Prereduction and postsurgery radiographic fracture characteristics were assessed. RESULTS: Female sex, being married, specific surgeons, carpal tunnel release, AO type C fractures, and greater catastrophic thinking were associated with increased distance to palmar crease at suture removal. At 6 weeks, greater catastrophic thinking was the only factor associated with increased distance to palmar crease. CONCLUSIONS: Catastrophic thinking was a consistent and major determinant of finger stiffness at suture removal and 6 weeks after injury. Future research should assess if treatments that ameliorate catastrophic thinking can facilitate recovery of finger motion after operative treatment of a distal radius fracture. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Catastrofização/epidemiologia , Catastrofização/psicologia , Fixação Interna de Fraturas/psicologia , Artropatias/psicologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Boston/epidemiologia , Comorbidade , Feminino , Articulações dos Dedos/patologia , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Artropatias/epidemiologia , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/psicologia , Prevalência , Fraturas do Rádio/epidemiologia , Fatores de Risco , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
14.
Aging Clin Exp Res ; 27(4): 539-46, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25708827

RESUMO

BACKGROUND: Fragility fractures of the proximal humerus and distal radius can have a significant impact on the elderly population, both economically and physically. Limited data are available to demonstrate the functional and economic impact of upper extremity fragility fractures. AIMS: To investigate the economic and social impact that proximal humerus fragility fractures may have on an older population. METHODS: A retrospective chart review for patients ≥50 years old treated as an inpatient at a local hospital between 2006 and 2012 for a proximal humerus or a distal radius fracture was done. Patients were divided into two groups to show age impact; Group 1 = 50-79 years old and Group 2 = 80 years and older. Eighty-six charts were reviewed, 38 for Group 1 and 48 for Group 2. Demographic, admission, inpatient, and discharge data were compared between groups. RESULTS: A third of patients in each group had a previous fragility fracture. Inpatient length of stay was comparable between groups. Surgical treatment was used at a higher rate in the younger cohort (p = 0.06). Approximate average hospital charges for an inpatient surgical treatment were about twice those of the non-surgically treated patients. DISCUSSION: Our results illustrate the significant burden of upper extremity fractures in terms of loss of independence, inpatient hospitalizations and prolonged nursing home or rehabilitation needs, which account for considerable health care costs. CONCLUSION: Fractures of the humerus, forearm and wrist account for one-third of the total incidence of fractures and can be a significant burden to individuals and the community.


Assuntos
Efeitos Psicossociais da Doença , Hospitalização , Fraturas por Osteoporose , Fraturas do Rádio , Reabilitação/economia , Fraturas do Ombro , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/economia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/psicologia , Fraturas por Osteoporose/terapia , Fraturas do Rádio/economia , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/etiologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/terapia , Estudos Retrospectivos , Fraturas do Ombro/economia , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/etiologia , Fraturas do Ombro/psicologia , Fraturas do Ombro/terapia , Mudança Social , Estados Unidos/epidemiologia
15.
Folia Med Cracov ; 55(2): 23-32, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26839240

RESUMO

AIM: The aim of this study was to identify and assess the degree and clinical course of the main health-related quality-of-life (HRQoL) issues in patients after a distal radius fracture (DRF). MATERIALS AND METHODS: Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3 months, and 6 after the fracture. Standard statistical analyses were performed. RESULTS: During the 16 month recruitment period a total of 71 patients (55 women - 77.5%), with a mean age of 64.1 ± 12.4 years, were included in the study group. All patients suffered from Colles type fractures. Attrition to follow-up was acceptable. At baseline, basing on the IOF QLQ scale scores, DRF patients had the most significant problems with physical function (82.8/100; with 100 representing the worst possible HRQoL), and general health (78.1/100). Basing on SF-36 scale scores patients most significant problems were associated with role limitations due to physical health problems (15.1/100; with 100 representing the best possible HRQoL), and bodily pain (39.5/100). CONCLUSIONS: Concluding, this study shows that the main issues with which patients with and extra-articular DRF struggle the most are pain of the fractured extremity and physical dysfunction. These symptoms are most pronounced in the early post-injury period, and in the majority of patients steadily decrease over a period of six months.


Assuntos
Nível de Saúde , Qualidade de Vida/psicologia , Fraturas do Rádio/psicologia , Fraturas do Rádio/reabilitação , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Adulto Jovem
16.
Dtsch Arztebl Int ; 111(46): 779-87, 2014 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-25491556

RESUMO

BACKGROUND: From 2000 to 2012, the annual incidence of inpatient treatment for distal radius fracture in Germany rose from 65 to 86 per 100 000 persons. It is unclear whether open reduction and volar angle-stable plate osteosynthesis (ORIF), a currently advocated treatment, yields a better functional outcome or quality of life than closed reposition and casting. METHODS: In the ORCHID multi-center trial, 185 patients aged 65 and older with an AO type C distal radial fracture were randomly assigned to ORIF or closed reposition and casting. Their health-related quality of life and hand/arm function were assessed 3 and 12 months afterward with the Short Form 36 (SF-36) questionnaire and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. The radiological findings, range of movement of the wrist, and EuroQol-5D (EQ-5D) scores were documented as well. RESULTS: Among the 149 patients in the intention-to-treat-analysis, there was no significant difference in SF-36 scores between the two treatment groups at one year (mean difference, 3.3 points in favor of ORIF; 95% confidence interval, -0.2 +6.8 points; p = 0.058). The DASH scores showed moderately strong, but clinically unimportant effects in favor of ORIF, and there was no difference in EQ-5D scores. ORIF led to better radiological results and wrist mobility at 3 months, with comparable results at 12 months. 37 of the patients initially allotted to nonsurgical treatment underwent secondary surgery due to significant loss of reduction. CONCLUSION: The findings with respect to mobility, functionality, and quality of life at 12 months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteosynthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures. Primary nonsurgical management is also effective in suitable patients.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Mal-Unidas/terapia , Qualidade de Vida/psicologia , Fraturas do Rádio/terapia , Contenções/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Feminino , Consolidação da Fratura , Fraturas Mal-Unidas/diagnóstico , Fraturas Mal-Unidas/psicologia , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/psicologia , Fatores de Risco , Resultado do Tratamento , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/psicologia , Traumatismos do Punho/terapia
17.
J Hand Surg Am ; 39(11): 2258-64.e2, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25283489

RESUMO

PURPOSE: To evaluate the effects of preoperative anxiety and catastrophic pain ideation on perceived disability and objective measures after distal radius fracture surgery. METHODS: A total of 121 patients with distal radius fractures treated with volar plate fixation were enrolled. The wrist range of motion (ROM), grip strength, and perceived disability as measured by the Michigan Hand Questionnaire (MHQ) score were assessed 4, 12, and 24 weeks after surgery. To evaluate psychological factors related to pain, catastrophic pain ideation was measured using the Pain Catastrophizing Scale (PCS) and pain anxiety was measured using the Pain Anxiety Symptom Scale (PASS). Then relative contributions of pain anxiety and catastrophic pain ideation and other clinical parameters to functional recovery in terms of grip strength, ROM, and MHQ score were assessed. RESULTS: An increase in the PCS score was associated with the wrist ROM and grip strength only at week 4, whereas an increase in the PASS score was associated with the wrist ROM at week 4 and grip strength at weeks 4 and 12. According to a multivariate regression analysis, an increase in the PCS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4; and an increase in the PASS score was associated with a decrease in grip strength, ROM, and MHQ score at week 4 and grip strength and MHQ score at week 12. At week 24, only age and fracture severity were associated with the MHQ score. In addition, age was associated with grip strength and fracture type was associated with ROM. CONCLUSIONS: Preoperative PCS and PASS were significantly associated with delayed recovery as evidenced by scores on both objective and subjective measures of function. Given these relationships, it becomes important to assess preoperative PCS and PASS and address issues for patients at risk with brief psychosocial intervention early in the recovery process. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.


Assuntos
Catastrofização/psicologia , Fixação Interna de Fraturas , Fraturas do Rádio/psicologia , Fraturas do Rádio/cirurgia , Adaptação Psicológica , Adulto , Idoso , Placas Ósseas , Catastrofização/fisiopatologia , Estudos de Coortes , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Placa Palmar/cirurgia , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Inquéritos e Questionários , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 15: 250, 2014 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-25059690

RESUMO

BACKGROUND: This study aimed to present functional results and patient's health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF). METHODS: Thirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted. RESULTS: Overall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved "good" or "excellent" results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period. CONCLUSION: The ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Qualidade de Vida , Fraturas do Rádio/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Áustria , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Desenho de Prótese , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/psicologia , Recuperação de Função Fisiológica , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
19.
J Hand Ther ; 27(3): 177-83; quiz 184, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24874854

RESUMO

STUDY DESIGN: Prospective cohort. INTRODUCTION: Effects of patient-centered care on distal radius fracture recovery lacks evidence. PURPOSE OF THE STUDY: To understand from the perspective of a patient with a distal radius fracture: if the Patient Perception of Patient-Centeredness Questionnaire (PPPC) subscales apply to distal radius fracture populations; the strongest and weakest areas of patient-centered care; changes in patient perceptions of patient-centeredness during recovery; and, correlations between aspects of patient-centered care and patient reported pain and disability. METHODS: Patients with distal radius fractures (n = 129; mean age = 54.03, SD = 14.63) completed the Patient Rated Wrist Evaluation (PRWE) and PPPC, at baseline (less than 10 days post-fracture) and at three months post-injury. Outcome measure responses were factor analyzed and tested for correlations. RESULTS: Factors identified were titled Clinician-Patient Dialogue, representing communication components of patient-centered care, and Clinician-Patient Alliance, representing partnership components of patient-centered care. Small significant correlations (r = 0.22) between PRWE and PPPC responses were observed with Clinician-Patient Alliance more correlated at baseline and Clinician-Patient Dialogue at follow-up. DISCUSSION: Important aspects of the patient-clinician dynamic were identified. CONCLUSIONS: Communication between clinician and patient was perceived most favorably at baseline; and partnership improved by three months. LEVEL OF EVIDENCE: 1b.


Assuntos
Satisfação do Paciente , Assistência Centrada no Paciente , Fraturas do Rádio/terapia , Adulto , Idoso , Estudos de Coortes , Comunicação , Cuidado Periódico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/prevenção & controle , Dor/psicologia , Relações Médico-Paciente , Fraturas do Rádio/complicações , Fraturas do Rádio/psicologia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Fatores de Tempo
20.
Folia Med Cracov ; 54(4): 35-44, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25891241

RESUMO

AIM: The aim of this study was to report preliminary validation data on the Polish version of the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a distal radius fracture (DRF). MATERIALS AND METHODS: Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. All patients filled out the Polish version of the IOF QLQ, the Short Form 36 (SF-36) and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, and 3 months after the fracture. Standard va- lidity and reliability analyses were performed. RESULTS: Fifty-eight patients (42 women - 72.4%) agreed to take part in the study (mean age of the group 65.7 ± 9.3 years). Cronbach's alpha coefficients showed positive internal consistency (0.82- 0.87). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.82 to 0.93. Satisfactory convergent and discriminant validity of the IOF QLQ was seen. CONCLUSIONS: Preliminary data show that the Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring health-related quality-of-life (HRQoL). However, further studies are needed to demonstrate the full psychometric and clinical properties of the IOF QLQ in patients with a fracture of the wrist.


Assuntos
Nível de Saúde , Qualidade de Vida/psicologia , Fraturas do Rádio/psicologia , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Fraturas do Rádio/terapia , Reprodutibilidade dos Testes , Traduções , Adulto Jovem
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