Psychosocial factors affecting variation in patient-reported outcomes after elbow fractures

Journal article

Background: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury.

Methods: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R 2, correlation matrices, and variable inflation factor assessment.

Results: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points.

Conclusions: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.

Authors: Jayakumar, P; Teunis, T; Vranceanu, A-M; Moore, MG; Williams, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Journal of Shoulder and Elbow Surgery
• Volume: 28
• Issue: 8
• Pages: 1431-1440
• Publication date: 2019-07-18
• Acceptance date: 2019-04-15
• DOI: 10.1016/j.jse.2019.04.045
• ISSN: 1532-6500
• Language: English
• Keywords: FFR; physical limitations; recovery; patient outcomes; psychosocial determinants; elbow fractures; resilience